The history of abortion-related acts and current issues in Japan

In Japan abortion is categorized into two types by law; one is illegal feticide and the other is legal abortion. The present criminal law forbids feticide in principle and the life of a fetus is protected. However, abortion can be practiced under the "Eugenic Protection Act" established in 1948 (currently referred to as the "Maternal Protection Act"), and is readily available in Japan. In this paper, I have traced the historical origins of abortion law and attempted to clarify the problems related to the current laws relating to artificial abortion. As a result, the existence of contradictions between attitudes toward the life of the fetus and that of the mother, women's right to self determination, and women's rights under current legislation has been clarified.     

The right to be born

The right to be born embodies several different rights: the right to be conceived, the right to be implanted in the uterus, and the right to live (or not be aborted). The right to be conceived, or the right of parents to reproduce, may depend upon circumstances. Do couples have the right to have children to whom they cannot offer an adequate upbringing? Do couples have the right to have as many children as they wish if in this way they will reduce the amount of food available to other families? Is the right to have children coupled with a responsibility not to have more children than a community, a country or the world can support? Fertilisation occurs in the fallopian tube, but only about 30% of fertilised ova normally become successfully implanted in the uterus. Fertilisation can also be achieved in a test tube and the resultant embryo then implanted in the mother's uterus to grow into a "test tube baby". Is it ethical to allow the use of donor sperm or ova, a surrogate mother, experimentation on embryos, and what should be done with "spare" embryos? The British Unborn Child (Protection) Bill 1986 prohibits anyone from possessing a fertilised embryo unless it is for the purpose of enabling a specific women to have a child. The right to live and not be aborted may involve a conflict of interests between a mother and her unborn child. A mother may claim absolute rights over her own body, including the right to have an abortion if she desires.(ABSTRACT TRUNCATED AT 250 WORDS)     

The placental transfer of cerium: experimental studies and estimates of doses to the human fetus from 141Ce and 144Ce

PURPOSE: To measure the transfer of cerium from mother to fetus in experimental animals and estimate doses to the human fetus following intakes of radioisotopes of Ce. MATERIALS AND METHODS: Cerium-141 in chloride solution was administered intravenously to rats at different stages of pregnancy (days 9.5, 12.5 or 18.5), and retention in the embryo/fetus and associated tissues was measured 3 days later in each case. Retention in rat fetal tissues on day 21.5 (shortly before birth) was also measured after administration of 141Ce chloride 1 month prior to conception or 141Ce citrate on day 18.5. Cerium-141 chloride was administered to guinea pigs on day 50 for measurements of fetal retention on day 57 (shortly before birth). RESULTS: Retention of 141Ce in the rat embryo/fetus, measured at 3 days after administration to the mother, increased from about 0.00002% of injected activity per embryo/fetus on day 12.5 to about 0.014% on day 21.5 of gestation. However, the relative concentrations of 141Ce in the embryo/fetus and mother (CF:CM ratio) were between 0.005 and 0.01 in each case. After 141Ce administration prior to conception, retention by the rat fetus on day 21.5 was substantially lower than after short-term administration. Comparison of retention of 141Ce on day 21.5 after administration on day 18.5 as either chloride or citrate showed similar levels in maternal tissues but greater transfer to the fetus (CF:CM ratio of 0.03). Retention in the guinea pig fetus in late gestation at 7 days after administration of (141)Ce chloride was about 0.05% injected activity per fetus, corresponding to a CF:CM ratio of about 0.02. CONCLUSION: These results and other published animal data have been used to specify CF:CM ratios for use in the calculation of doses to the human fetus. The values used were 0.05 for intakes during pregnancy and 0.01 for intakes prior to conception. Doses to the offspring after maternal ingestion of 141Ce or 144Ce are largely due to irradiation from activity in the maternal colon and are insensitive to CF:CM. After inhalation, however, absorption of Ce to blood is much greater and doses to the offspring are dominated by the contribution from activity in the fetus, and therefore dependent on the CF:CM ratio used.     

Abortion in Islamic countries--legal and religious aspects

The debate over abortion is still controversial as ever. As one of every four people in the world is of the Muslim religion, it is important to learn more about the Islamic point of view toward this dilemma in medical ethics. The first part of this paper gives a general view of the sources of Islamic law and discusses modern developments in Islamic medical ethics regarding abortion. The second part focuses on the legal aspects of abortion in different Islamic states, dealing with the need to supply solutions to women who for different reasons wish to abort and at the same time enact laws that would not contradict Islamic principles. A study of three Muslim states (Egypt, Kuwait and Tunisia) demonstrates three different approaches toward legalizing abortion--a conservative approach, a more lenient approach, and a liberal one--all within Islamic oriented states. This leads to a conclusion that a more liberal attitude regarding abortion is possible in Islamic states, as long as traditional principles are taken into account.     

Protecting the unborn clone: can law and science evolve together?

The courts have treated the unborn child as neither person nor property. Human cloning will challenge this legal principle. Human cloning provides options for future scientific development and treatment of disease and infertility. However, cloning gives rise to issues not yet considered, in law, let alone resolved. These issues are not present in the context of normal human birth. At present, the common law restricts its scope to normal human birth. Does the donor "own" their unborn clone? Who makes decisions on behalf of the unborn clone? The gap between science and law is too large in human cloning research. Law lags behind in adapting to new technologies. This paper will address legal issues in relation to the unborn clone. Cloning will challenge the law in its current state. Decision-making and control of the unborn child are vital issues, to be determined before human cloning can be permitted to take place. The individuals who might have an interest in the unborn clone include the donor, the scientist, who either developed the finished clone or stored the clone prior to implantation, and the surrogate mother. Claims or conflicts might arise in many areas of medicine and law. Does the scientist have an intellectual property right? Can the surrogate mother terminate the pregnancy at will? If the unborn clone is not aborted, what measures are required to protect the fetus? Can the surrogate mother be liable for neglect? Who decides about disclosure of information and knowledge or choice regarding fetal diagnosis and treatment? Who has custody of the unborn clone? In this paper, the concepts of trusts are explored to develop a means of resolving conflicts among the individuals who might claim an interest in the unborn clone. The trust doctrine is flexible and may be useful in resolving claims or conflicts.     

A descriptive analysis of South African and Islamic abortion legislation and local Muslim community responses

The issue of abortion has been the subject of much debate in the recent past in South Africa. Prior to 1996 abortion legislation was punitive and therefore one with which conservative Muslims could identify. Since 1996 the law has been liberalized and replaced by a new Act. The final Constitution (1996) took a neutral stance regarding abortion. The enactment of the Choice on Termination on Pregnancy Act (1996) finally ensured this right. The Act, a critical milestone for gender equality, secured all South African women (including minors) the right to make decisions about reproduction and according to their individual beliefs. Muslim organizations participated in this abortion debate making formal but opposing submissions to Parliament. These opposing views of Muslims came as no surprise and reflect the different norms of Islamic law which varies between countries and was indicative of the interpretative duality evident in most matters of Islamic law.     

Awareness and views of the law on termination of pregnancy and reasons for resorting to an abortion among a group of women attending a clinic in Colombo,Sri Lanka

In Sri Lanka, induced abortion is a criminal offence except to save the life of the mother. This study determined the awareness and views of the law on abortion among women seeking an abortion. Three hundred and thirteen women were interviewed. The characteristics of the study group are discussed. 65.8% of the respondents stated they knew the current law, 25.6% stated they did not and 8.3% were unsure. On detailed analysis of each respondent’s knowledge regarding the situations where abortion is legalized including those who stated that they did not know the law, only 11.2% had an accurate knowledge. More than 75% stated that abortion should be legalized when the mother’s life was in danger, where there was pregnancy after rape or incest, when there was psychiatric illness in the mother and when there were fetal anomalies. Reasons for resorting to an abortion are discussed. Although 11.2% were aware of the law, there was no difference in the reasons for resorting to an abortion when compared with those who were unaware of the law. This study highlights the fact that availability of abortion services to women depend not only on the law and its awareness, but on how it is interpreted and enforced.     

University students' attitudes towards Voluntary Interruption of Pregnancy

An evaluation of the future professional trends was performed by analyzing the attitudes of university students to the Voluntary Interruption of Pregnancy (VIP). An anonymous questionnaire was distributed to 300 students (Medicine, Nursing and Law) of the University of Santiago de Compostela, with questions on their personal beliefs, opinion on the law and intention to participate in VIP. Of the 245 respondents (response rate 82%), 66.5% were pro-abortion and their attitudes towards VIP were consistent with their opinion on the beginning of life and with the ethical arguments related to the fetus and the mother. No differences were found with age, sex or degree. The students showed to be well informed on the VIP law, and the majority of them considered unsuitable termination of pregnancy in minors without parental consent. Students' intentions to take part in abortion provision were influenced by their views on abortion, level of participation and circumstances of pregnancy. Although the majority of participants would be willing to perform VIP in situations that affect fetus and mother's life or health (87-66%), their intentions clearly diminished in other situations, such as abortion on demand (17%). These data suggest that conscientious objection of health professionals can even increase with the new policy, a fact that might affect VIP availability. It is important to stress the need of ethical training to help in the solution of conflicts between patient and health professional values.     

Forensic considerations of surrogacy -- an overview

In the past two decades, there has been a spectacular change in the field of reproductive technologies. Reproductive sciences have come in with techniques such as donor insemination; in vitro fertilization and embryo transfer methods, which have completely revolutionized the reproductive environment. These techniques have given hope to many infertile couples, who wish to have a child of their own. With the oncoming of surrogacy agreements, concepts of fatherhood and motherhood have been subject to much controversy. Motherhood was never under much scrutiny as it was rightly thought that childbirth was the natural and conclusive fact establishing it, though paternity was at times a controversial concept burdening legislators to provide for suitable tests. Medical sciences have now compartmentalized motherhood into the genetic, gestational and the social mother leading to a clash of interests. This paper reviews some medicolegal, ethical and social aspects of surrogacy.     

Abortion policy in Turkey: current ethical attitudes

The authors outline the development of abortion law in Turkey, and relate ethical attitudes to current practice, especially in connection with policies of population control, and the institution of secular law in a previously Islamic legal framework.     

输卵管积水的栓塞治疗

目的探讨和评价输卵管积水栓塞治疗方法的可行性。方法在X线透视监视下,行输卵管选择性插管,将微弹簧圈通过微导管送入输卵管近端,达到栓塞输卵管的目的。结果输卵管栓塞98例患者,双侧输卵管栓塞66例,单侧输卵管栓塞32例,共栓塞164侧输卵管,插管均一次性成功。输卵管栓塞后1个月行子宫输卵管造影术,显示有效者164侧为100%,其中显示最佳效果者136侧输卵管,占82.9%;无效者为0。结论输卵管栓塞的介入治疗是行之有效的方法,与目前采用的方法相比,无手术并发症,简便,安全,经济,对卵巢功能无影响。     

The incorporation of plutonium by the embryo and fetus of rats and guinea-pigs.

The transfer of 238Pu from the maternal circulation to the developing embryo and fetus was studied in rats and guinea-pigs to provide data for the development of dosimetric models for the human embryo and fetus. Following administration at different stages of gestation, measurements were made after 3 days in the rat and 7 days in guinea-pigs. The amount transferred was greater after administration at later stages of gestation, up to a maximum of about 0.8-0.9% of the injected activity per fetoplacental unit (FPU) and about 0.2% per fetus in both species. In advanced gestation the yolk sac, the initial site of haemopoietic stem cells, contained up to 80% of the total activity in the FPU in rats, compared with about 25% for the guinea-pig; retention in placental trophoblast was greater in the guinea-pig. The concentrations of 238Pu in the yolk sac were generally about two to three orders of magnitude greater than fetal concentrations and of the same order as in maternal liver and bone. In both species, concentrations in the embryo and fetus were greatest after injection early in gestation, reached their lowest around mid-organogenesis and increased again in later gestation. The fetus:mother whole-body concentration ratios in late gestation were about 0.1 and 0.05 in rats and guinea-pigs, respectively. Measurements were also made of the 238Pu retention in neonates at birth. In guinea-pigs the liver accounted for about 6-9% of retained activity; similar values for femora indicated skeletal retention of about 60-80%. For administration at each stage of gestation, and particularly at early stages, transfer of 238Pu to the fetus continued throughout gestation but concentrations decreased due to fetal growth.     

Legal regulation of surrogate motherhood in Israel

The Israeli Law on surrogate motherhood demands a preconception agreement to include payments to be made to the surrogate mother. Surrogacy arrangements with family members are forbidden. Commercial surrogacy is allowed and encouraged. The Law causes many problems. Validity of consent given by surrogate mothers is doubtful. Possible future psychological harm are ignored. There is a danger of "commodification" of children. Abusing women of low socio-economic status as breeding machines may be another outcome. No clear responsibility is imposed on the "intended parents" for an impaired child. The law ignores possibility of divorce or death of the "intended parents" before the child's birth. Splitting motherhood is another social problem that has to be dealt with. So far the sperm of the husband from the "intended parents" has to be used, but further steps may follow. It is not certain that a policy of "positive eugenics" will not develop.     

Fatal non-traumatic spontaneous hemoperitoneum in second trimester of pregnancy--autopsy findings

Spontaneous hemoperitoneum in second trimester of pregnancy is a very rare but lethal condition which demands prompt diagnosis and management for the survival of both mother and fetus. A 21-year old primigravida woman was presented at 29 weeks of pregnancy with acute abdominal pain and hypovolumic shock. In a District Hospital patient was managed conservatively and referred but was brought dead at tertiary level hospital. On autopsy gross hemoperitoneum was found without any injury and uterine artery found ruptured against the suspicion of brutal beating by the relatives of husband.     

Sonographic evaluation of normal and induced ovulation

The adult premenopausal ovary exists in a dynamic state of flux, with ovarian position, size, activity, and structure constantly undergoing changes. Pelvic sonograms must be interpreted with knowledge of the stage of the menstrual cycle and the expected normal range of sonographic findings, because features that are normal in one phase may be abnormal in another. Only against this background knowledge can the challenging task of interpretation of pelvic sonograms be successfully performed. US also plays an increasingly important role in monitoring ovulation induction and alternative methods of fertilization and has improved pregnancy rates by distinguishing between the presence of one or more mature follicles as opposed to a cohort of immature follicles, suggesting the possibility of multiple ovulation with the risks of hyperstimulation or poor pregnancy outcome from multiple gestation, indicating optimum timing of human chorionic gonadotropin administration, allowing detection and confirmation of normal follicular rupture and ovulation, indicating optimum timing of oocyte retrieval in programs of in vitro fertilization with embryo transfer (IVF-ET) or insemination programs, and assessing pathologic pelvic conditions and ovarian accessibility in IVF-ET programs. Oocyte retrieval and embryo transfer are also being performed under US guidance.     

From the dead to the unborn: is there an ethical duty to save life?

In this paper I examine the question whether physicians have a legal and ethical duty to sustain pregnancies of women who die during the first or second trimester by the delivery of their fetuses. One ground for such a duty, on which I am focusing, is the duty of "special relationship" between the mother and the fetus. In my paper, I claim that the special relations the pregnant woman and the fetus have do provide such a moral duty. This moral duty derives from the special and intimate relationship between the mother and the fetus, which has two considerations that support it: the uniqueness of the fetus, and the mother's understanding and acknowledgement of such uniqueness. However, I argue that when the mother is dead, the nature of the relationship changes, as she is no more aware of her fetus and her relationship with it. Thus, the ethical duty of the mother to save her fetus' life should be declined upon the end of the relationship between the mother and her fetus with the mother's death. I support my argument by analyzing the special relationship between the mother and the fetus from four related ethical theories: ethics of relationships, responsibilities to society, ethics of families, and the ethics of care. By discussing these ethical theories, I show how responsibility to society in general, and to social entities, like families, in particular, constitute a moral duty towards the fetus, which, as aforesaid, no longer exists upon the pregnant woman's death. In addition to being social entities I further show how the intrinsic values of families play an important role in forming such a moral duty. Nevertheless, I argue that such an instrumental duty that enables the establishment of families no more exists as the pregnant woman is no more socially and morally part of the family she belonged to while alive. I strengthen my argument by applying ethics of care, and by analyzing the practical conclusion I arrived at from a religious perspective.     

Legal aspects of obstetric sonography

The combination of rapid innovation and high risk obstetric sonography has resulted in increased potential for litigation: 80% of suits in sonography are obstetric-related. These suits come under the category of tort law, where damages are sought to compensate those whose interests have been harmed. To win a claim the plaintiff must prove that a legal duty has been breached, that damages have been incurred, and that the breach was the legal as well as the actual cause of the damage. Although it is not possible to claim that the radiologist caused the damage, damages to a living being, the fetus, are being awarded for several types of claims. Wrongful pregnancy claims are being awarded costs of the pregnancy and childbirth in cases of failed sterilization or abortion. Wrongful birth suits arise from negligent genetic counseling when the infant is born defective, and the anomalies are diagnosable but overlooked. Wrongful life suits, brought by the defective individual, are controversial for their large monetary awards, as well as the ethical question whether impaired life is better than no life at all. Only 4 states recognize these claims. Wrongful death suits are applicable where therapy under sonographic guidance causes death of the fetus. Agency law applies where an error is committed by a technologist in a radiologist's employ. It is recommended that the radiologist follow American College of Radiology guidelines for fetal surveys; obtain follow-up or a 2nd opinion in case of an abnormality; keep written notes of normal fetal structures; keep abreast of local case law and legislation; rescan patients after the technologist's exam; and document and report promptly all normal and abnormal findings.     

The Incorporation of Plutonium by the Embryo and Fetus of Rats and Guinea-pigs

Summary

The transfer of ²³⁸Pu from the maternal circulation to the developing embryo and fetus was studied in rats and guinea-pigs to provide data for the development of dosimetric models for the human embryo and fetus. Following administration at different stages of gestation, measurements were made after 3 days in the rat and 7 days in guinea-pigs. The amount transferred was greater after administration at later stages of gestation, up to a maximum of about 0·8–0·9% of the injected activity per fetoplacental unit (FPU) and about 0·2% per fetus in both species. In advanced gestation the yolk sac, the initial site of haemopoietic stem cells, contained up to 80% of the total activity in the FPU in rats, compared with about 25% for the guinea-pig; retention in placental trophoblast was greater in the guinea-pig. The concentrations of ²³⁸Pu in the yolk sac were generally about two to three orders of magnitude greater than fetal concentrations and of the same order as in maternal liver and bone. In both species, concentrations in the embryo and fetus were greatest after injection early in gestation, reached their lowest around mid-organogenesis and increased again in later gestation. The fetus:mother whole-body concentration ratios in late gestation were about 0·1 and 0·05 in rats and guinea-pigs, respectively. Measurements were also made of the ²³⁸Pu retention in neonates at birth. In guinea-pigs the liver accounted for about 6–9% of retained activity; similar values for femora indicated skeletal retention of about 60–80%. For administration at each stage of gestation, and particularly at early stages, transfer of ²³⁸Pu to the fetus continued throughout gestation but concentrations decreased due to fetal growth.     

Sibling incest and formulation of paternity probability: case report

Paternity determination of a fetus whose mother was admitted to an institution for the welfare and health of handicapped persons was requested of us by a doctor and lawyer of the institution. The fetus was recovered by a legal artificial abortion based on the Act on Maternity Health and Welfare (Japan) with the permission of the custodian. Commercially available MCT118, HLADQA, PM, and 9 STRs were tested for DNA samples from the fetus, the mother, her younger brother, her father, her grandfather, and 4 staff members of the institution. Only the brother was not excluded and the paternity probability was estimated at 99.857% on the basis of newly formulated expressions for multiallelic loci on the assumption of sibling incest. We concluded then that the fetus was fathered by the brother. DNA fingerprinting with multilocus and single locus minisatellite probes which were performed to confirm the paternity also support the conclusion. Bandsharing frequencies between the family members, however, did not necessarily reflect their actual kinship, which findings suggest that multilocus DNA fingerprinting requires further accumulation of data for consanguineous cases such as incest. Universal formulation for calculating paternity probability for a sibling incest case on the basis of multiallelic monolocus polymorphisms is also presented.     

Development of computational pregnant female and fetus models and assessment of radiation dose from positron-emitting tracers

Purpose

Molecular imaging using PET and hybrid (PET/CT and PET/MR) modalities nowadays plays a pivotal role in the clinical setting for diagnosis and staging, treatment response monitoring, and radiation therapy treatment planning of a wide range of oncologic malignancies. The developing embryo/fetus presents a high sensitivity to ionizing radiation. Therefore, estimation of the radiation dose delivered to the embryo/fetus and pregnant patients from PET examinations to assess potential radiation risks is highly praised.

Methods

We constructed eight embryo/fetus models at various gestation periods with 25 identified tissues according to reference data recommended by the ICRP publication 89 representing the anatomy of the developing embryo/fetus. The developed embryo/fetus models were integrated into realistic anthropomorphic computational phantoms of the pregnant female and used for estimating, using Monte Carlo calculations, S-values of common positron-emitting radionuclides, organ absorbed dose, and effective dose of a number of positron-emitting labeled radiotracers.

Results

The absorbed dose is nonuniformly distributed in the fetus. The absorbed dose of the kidney and liver of the 8-week-old fetus are about 47.45 % and 44.76 % higher than the average absorbed dose of the fetal total body for all investigated radiotracers. For ¹⁸F-FDG, the fetal effective doses are 2.90E-02, 3.09E-02, 1.79E-02, 1.59E-02, 1.47E-02, 1.40E-02, 1.37E-02, and 1.27E-02 mSv/MBq at the 8th, 10th, 15th, 20th, 25th, 30th, 35th, and 38th weeks of gestation, respectively.

Conclusion

The developed pregnant female/fetus models matching the ICRP reference data can be exploited by dedicated software packages for internal and external dose calculations. The generated S-values will be useful to produce new standardized dose estimates to pregnant patients and embryo/fetus from a variety of positron-emitting labeled radiotracers.