Between “Medical” and “Social” Egg Freezing

Egg freezing has led to heated debates in healthcare policy and bioethics. A crucial issue in this context concerns the distinction between “medical” and “social” egg freezing (MEF and SEF)—contrasting objections to bio-medicalization with claims for oversimplification. Yet such categorization remains a criterion for regulation. This paper aims to explore the “regulatory boundary-work” around the “medical”–”social” distinction in different egg freezing regulations. Based on systematic documents’ analysis we present a cross-national comparison of the way the “medical”–”social” differentiation finds expression in regulatory frameworks in Austria, Germany, Israel, and the Netherlands. Findings are organized along two emerging themes: (1) the definition of MEF and its distinctiveness—highlighting regulatory differences in the clarity of the definition and in the medical indications used for creating it (less clear in Austria and Germany, detailed in Israel and the Netherlands); and (2) hierarchy of medical over social motivations reflected in usage and funding regulations. Blurred demarcation lines between “medical” and “social” are further discussed as representing a paradoxical inclusion of SEF while offering new insights into the complexity and normativity of this distinction. Finally, we draw conclusions for policymaking and the bioethical debate, also concerning the related cryopolitical aspects.

Ethical Implications of Electroconvulsive Therapy: A Review

This article examines in depth whether electroconvulsive therapy (ECT) satisfies bioethics’ four healthcare provision principles: nonmaleficence, beneficence, justice, and autonomy. Treating patients ethically implies protecting them from damages, working to ensure their well-being, and respecting their decisions once they have been correctly informed. Although most of the medical literature states that ECT is an effective and safe technique, there is no conclusive evidence of long-term effectiveness. The frequent and sometimes persistent side effects such as amnesia that imply a profound disturb of lived experience, or the difficulties regarding the informed consent process, allow us to conclude that the bioethical debate about ECT is not currently closed, and the information provided to patients needs to be revised.

Transparency or restricting gifts? Polish medical students’ opinions about regulating relationships with pharmaceutical sales representatives

Relationships between physicians and pharmaceutical sales representatives (PSRs) often create conflicts of interest, not least because of the various benefits received by physicians. Many countries attempt to control pharmaceutical industry marketing strategies through legal regulation, and this is true in Poland where efforts are underway to eliminate any practices that might be considered corrupt in medicine. The present research considered Polish medical students’ opinions about domestic laws restricting doctors’ acceptance of expensive gifts from the industry, the idea of compulsory transparency, and the possibility of introducing a Polish Sunshine Law. A qualitative, focus group-based, interview method was used. Data were gathered from nine focus groups involving 92 medical students from three universities located in major Polish cities. The article presents a classification of opposing student views with regard to the consequences of introducing different legal solutions; this should be useful for policy makers deliberating on how to optimally regulate pharmaceutical marketing. The study’s results are discussed in the context of the public bioethical debate in Poland.

The theorisation of ‘best interests’ in bioethical accounts of decision-making

Background Best interests is a ubiquitous principle in medical policy and practice, informing the treatment of both children and adults. Yet theory underlying the concept of best interests is unclear and rarely articulated. This paper examines bioethical literature for theoretical accounts of best interests to gain a better sense of the meanings and underlying philosophy that structure understandings. Methods A scoping review of was undertaken. Following a literature search, 57 sources were selected and analysed using the thematic method. Results Three themes emerged. The first placed best interests within the structure of wider theory, noting relationships with consequentialism, deontology, prudential value theory, rights and political philosophy. The second mapped a typology of processes of decision-making, among which best interests was ambiguously positioned. It further indicated factors that informed best interests decision-making, primarily preferences, dignity and quality of life. The final theme considered best interests from a relational perspective. Conclusions Characterisation of best interests as strictly paternalist and consequentialist is questionable: while accounts often suggested a consequentialist basis for best interests, arguments appeared philosophically weak. Deontological accounts, found in law and Kantianism, and theories of political liberalism influenced accounts of best interests, with accounts often associating best interests with negative patient preferences (i.e. individual refusals). There was much more emphasis on negative interests than positive interests. Besides preference, factors like dignity and quality of life were held to inform best interests decisions, but generally were weakly defined. To the extent that preferences were unable to inform decision making, decisions were either made by proxy authority or by an intersubjective process of diffuse authority. Differing approaches reflect bifurcations in liberal philosophy between new liberalism and neo-liberalism. Although neither account of authority appears dominant, bias to negative interests suggests that bioethical debate tends to reflect the widespread ascendancy of neo-liberalism. This attitude was underscored by the way relational accounts converged on private familial authority. The visible connections to theory suggest that best interests is underpinned by socio-political trends that may set up frictions with practice. How practice negotiates these frictions remains a key question.

Sanctity of Human Life in Bioethics

Sanctity of human life plays important role in bioethics since the beginning of human life until its natural death. Sanctity of human life does not belong exclusively to religions but also to secular bioethical debate. One of the most important meanings of sanctity of human life is that human life should not be violated, opposed or destroyed, and, positively that it should be protected, defended and preserved. Preservation of human life is central in bioethics as an ethics of life because life is the most important property of human beings.

Will Human Dignity Remain Inviolable? [2004]

For decades, Article 1 of the German Basic Law was interpreted in accordance with the view that human dignity belongs to human beings as such. In other words, Article 1 guarantees respect for the dignity of human beings and thus of every individual. In this article—originally published to intense debate in the Frankfurter Allgemeine Zeitung— Böckenförde argues that the traditional view was gradually undermined on two different fronts: by jurists who argue that human dignity belongs to human beings only after birth, and by those who argue that human dignity gradually develops from conception until birth. Legal scholar Matthias Herdegen, who wrote the new interpretation of Article 1 in the influential Basic Law commentary ‘Maunz-Dürig’, holds the latter position. Böckenförde regards the adoption of this new interpretation in the authoritative commentary both as a shock to the foundation of the constitution and as a disregard for the intent of the constitutional framers. The political and societal background of this shift is the bioethical debate: the possible benefit to be gained from embryonic stem cell research, the question of whether parents should be allowed to select between in-vitro embryos after genetic screening, and so forth. Böckenförde is very critical of this development. If the interpretation of the constitutional guarantee of human dignity is changed to fit changing social attitudes, Böckenförde argues, we should be concerned about the binding nature of the constitution as such.

Anesthesia for rabbits submitted to experimental surgeries: Report of a series of eight anesthesias

Anesthesia for laboratory animals is a matter of biomedical concern and one of the most present dilemmas in the current bioethical debate. The use of anesthetic agents in experimental surgery aims at analgesia and restraining the animal, in order to achieve a reasonable degree of muscle relaxation and to produce sufficient analgesia. This practice requires the use of protocols for the administration of safe and efficient doses. Eight New Zealand rabbits were submitted to laparotomies demonstrating the surgical technique discipline of the local medical course. For pre-anesthetic medication, acepromazine 1 mg.kg-1 associated with ketamine 15 mg.kg-1 was used subcutaneously. Anesthesia was maintained with isoflurane and oxygen under a laryngeal mask in a Mapleson D anesthesia system and under spontaneous breathing. Hydration was performed with 10 ml.kg-1 saline every hour. A thermal mattress was used. Precordial stethoscope, pulse oximetry and clinical parameters were used for monitoring. For euthanasia, ketamine 10 mg.kg-1 associated with potassium chloride 19.1% 1 ml.kg-1 was used intravenously. The average weight of the rabbits was 2721.25 ± 275.01 grams and the duration of the anesthetic procedure was 120 ± 87 minutes. Discussion. In long-term anesthesia, such as laparotomies, the use of pre-anesthetic medication and then anesthetic induction by the combination of agents is recommended. However, anesthetic management requires monitoring to prevent insufficient or excessive doses from occurring.

The right to know: ethical implications of antibody testing for healthcare workers and overlooked societal implications

After the initial surge in cases of coronavirus (COVID-19), the outbreak has been managed differently in different countries. In the USA, it has been managed in many different ways between states, cities and even counties. This disparity is slowly becoming more and more pronounced with the advent of antibody testing. Although many argue over the potential merits of antibody testing as an immunity passport to allow the economy to restart, there are other implications that stand at the heart of the bioethical debate that are often overlooked. Particularly with COVID-19, there are many uncertainties and the discourse alone of antibodies presumes misinformation that may outweigh the epidemiological benefits of antibody testing. Although this paper does not seek to eliminate antibody testing, it does highlight the need for appropriate counselling both on a personal level with each patient but on a more global level. This moral standard of appropriate education is key to allowing the continued autonomy needed during this pandemic.

Bioethical Debate, Reflections and Standards. Urban Bioethics spotlight

The process of creation of a new direction in bioethics - urban - is extremely important in the global world. Ukraine, as a post-socialist country, is a perspective field for urban researches. On the one side, it has a bright, specific culture, and on the other, the “invisible” citizens, whose voices remain unheard during the transformational modern conversions. Participation in the conference on May 17-18, in Rijeka, is an opportunity to study the experience of different countries, different economic systems, etc. to increase attention and understanding of the cultural and value context on the example of the particular urban cases. The analysis of the conference does not pretend to enlighten the contents of the conference comprehensively, but rather to highlight the own impression of participation and to encourage discourse in the field of new bioethics direction.