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Theoretical Medicine and Bioethics Aug 2023In a thought-provoking article - or how she herself named it, 'a thought experiment' - the philosopher-medical ethicist Anna Smajdor analyzed in this journal the idea of...
In a thought-provoking article - or how she herself named it, 'a thought experiment' - the philosopher-medical ethicist Anna Smajdor analyzed in this journal the idea of whole-body gestational donation (WBGD) in brain-dead female patients, as an alternative means of gestation for prospective women who cannot or prefer not to become pregnant themselves. We have serious legal, economical, medical and ethical concerns about this proposal. First, consent for eight months of ICU treatment can never be assumed to be derived from consent for post-mortem organ donation; these two are of an incomparable and entirely different medical and ethical order. Moreover, the brain-dead woman is very likely to be medically unfit for high-tech surrogacy and the brain-dead state poses a high risk for deficient embryo/fetal development. Second, from a scarcity perspective, occupying an ICU bed for eight months appears to be unjust. The costs for eight months of ICU treatment are far too high compared to the costs of surrogacy for a living, selected, and healthy woman. Neither insurance companies nor prospective parents will want to pay these exceptionally high costs for a dead woman if a living surrogate mother can be hired for a considerably lower amount. Third, there is an increased risk for harm of the child to be in WBGD. And finally, WBGD risks violating the brain-dead woman's dignity and harming the interests of her loved ones. In short, there is simply no need for brain-dead women as surrogates.
Topics: Female; Child; Pregnancy; Humans; Prospective Studies; Brain Death; Health Status; Parents
PubMed: 37606813
DOI: 10.1007/s11017-023-09642-2 -
Culture, Health & Sexuality Jun 2024Building on existing scholarship examining how audiences interpret reproductive experiences on film and television, we investigate how viewers make meaning of...
Building on existing scholarship examining how audiences interpret reproductive experiences on film and television, we investigate how viewers make meaning of representations of motherhood, abortion, adoption, and surrogacy on the Hulu television miniseries . We recruited twenty-one participants to watch the series and conducted three virtual focus groups of seven women each. Based on the racial identities of the main characters in the series, we segmented these groups by race: one group each of white women, Black women, and Chinese American women. Focus groups were facilitated by moderators who matched the racial and ethnic backgrounds of each group. We asked participants about their overall reactions to the series, their impressions of various characters, and each reproductive health plotline. Participants expressed both tender and critical reactions to characters who endured motherhood, surrogacy and adoption, yet most participants were overtly critical of Lexie, the character who obtained an abortion. We argue that this is likely because the character of Lexie is written as largely unsympathetic, leaving audiences with little opportunity to form a parasocial relationship with her. We discuss the implications of this for cultural conversations and understandings of abortion more broadly.
Topics: Humans; Female; Adult; Abortion, Induced; Focus Groups; Adoption; Surrogate Mothers; United States; Television; Pregnancy; Young Adult
PubMed: 37548147
DOI: 10.1080/13691058.2023.2242436 -
Frontiers in Pediatrics 2023Low cardiac output syndrome (LCOS) is a significant cause of morbidity and the leading cause of mortality after pediatric cardiac surgery. Levosimendan has been shown...
INTRODUCTION
Low cardiac output syndrome (LCOS) is a significant cause of morbidity and the leading cause of mortality after pediatric cardiac surgery. Levosimendan has been shown safe and effective in pediatrics to treat LCOS. We aimed to review our local strategy with preoperative prophylactic Levosimendan infusion to minimize LCOS after heart surgery in identified high-risk patients.
METHODS
Retrospective monocentric study. As there is no reliable cardiac output measurement in children, we recorded hemodynamic parameters as surrogates of cardiac output after extracorporeal circulation through an electronic patient survey system at different time points.
RESULTS
Seventy-two children received Levosimendan before surgery between 2010 and 2019. As expected, most patients were newborns and infants with prolonged open-heart surgeries. Median cardiopulmonary bypass time was 182 [137-234] min, and aortic clamping time was 95 [64-126] min. The postoperative hemodynamic parameters, vasoactive-inotropic score, and urine output remained stable throughout the first 48 h. Only a tiny portion of the patients had combined surrogate markers of LCOS with a maximal median arterial lactate of 2.6 [1.9-3.5] mmol/L during the first six postoperative hours, which then progressively normalized. The median arterio-venous difference in oxygen saturation was 31 [23-38] % between 12 and 18 h post-surgery and gradually decreased. The median venous-to-arterial CO2 difference was the highest at 10 [7-12] mmHg between 12 and 18 h post-surgery. Nine patients (13%) required extracorporeal membrane oxygenation. No patient required dialysis or hemofiltration. Mortality was 0%.
CONCLUSION
Before congenital heart surgery, preoperative prophylactic administration of Levosimendan seems effective and safe for decreasing occurrence and duration of LCOS in high-risk children.
PubMed: 37539009
DOI: 10.3389/fped.2023.1205971 -
Journal of Health Psychology Mar 2024Concerning Europe, the lay public, mainly in Central regions, still lacks information about what surrogacy is and how the process works in practice. It is one of the...
Concerning Europe, the lay public, mainly in Central regions, still lacks information about what surrogacy is and how the process works in practice. It is one of the most controversial methods of assisted reproduction precisely because it goes against traditional social norms and ideas about the conception of life. The main aim of our study was to map the social representations of lay people that are formed in internet discussions. We focused on discussion forums over a time span of the last 10 years, from 2013 to 2022. We were also interested in whether perceived risks or benefits formed the core of social representations. Through a reflexive thematic analysis, we identified two distinct constructions of social representations of surrogacy, finding that value settings in terms of liberalism and conservatism appear to have the greatest influence on the anchoring and objectification of surrogacy.
Topics: Pregnancy; Female; Humans; Surrogate Mothers; Europe; Social Norms
PubMed: 37534593
DOI: 10.1177/13591053231189411 -
Human Reproduction (Oxford, England) Oct 2023What are the experiences of single men using egg donation and surrogacy as a route to parenthood?
STUDY QUESTION
What are the experiences of single men using egg donation and surrogacy as a route to parenthood?
SUMMARY ANSWER
The fathers mainly had a positive relationship with the surrogate and simultaneously exercised agency, and experienced challenges, during the process of surrogacy.
WHAT IS KNOWN ALREADY
Little is known about single men's experiences of egg donation and surrogacy arrangements. Studies have focused on single men's decision-making processes about the use of surrogacy and family functioning once these families are formed. Questions remain about how fathers experience and navigate the process of surrogacy as a single man.
STUDY DESIGN, SIZE, DURATION
The study is an international, in-depth qualitative study of fathers who chose to begin a family and parent alone. Data were collected between 2018 and 2021 as part of a larger study of solo fathers with different routes to parenthood. The present study reports on 21 fathers who used surrogacy and egg donation to begin their family. The average age of the fathers was 44 years, the fathers had young children aged 6 years or younger, and lived in countries across Australia, Europe, and North America.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Purposive sampling was used to recruit participants. In-depth semi-structured interviews were conducted. Interview topics included fathers' experiences of the process of using egg donation and surrogacy, and navigating the relationship with the surrogate. The audio-recorded interviews lasted around 2 hours and were subsequently transcribed verbatim.
MAIN RESULTS AND THE ROLE OF CHANCE
Data were analysed using reflexive thematic analysis and qualitative content analysis. Most of the fathers chose an identifiable egg donor. Regarding the relationship with the surrogate, many fathers had remained in contact with her, but to differing degrees, and they generally reported positive relationships. Thematic analysis led to the identification of three themes relating to the fathers' experiences of choosing surrogacy as a single man: the ability to make choices; challenges and constraints; and special relationship.
LIMITATIONS, REASONS FOR CAUTION
Due to the variation between different countries regarding laws on surrogacy, contextual factors may have impacted on the experiences of single fathers, and the sample size was small. However, the research provides new insights into an area with little academic literature.
WIDER IMPLICATIONS OF THE FINDINGS
Given the growing trend of single men having children through surrogacy, the findings suggest that this new path to parenthood can be both rewarding and challenging. Single men may benefit from tailored support and counselling to help them navigate the surrogacy journey.
STUDY FUNDING/COMPETING INTEREST(S)
This study was funded by the Wellcome Trust (grant number 208013/Z/17/Z). The authors have no conflicts of interest to declare.
TRIAL REGISTRATION NUMBER
n/a.
Topics: Humans; Male; Child; Pregnancy; Female; Child, Preschool; Adult; Surrogate Mothers; Men; Counseling; Europe; Fathers
PubMed: 37528054
DOI: 10.1093/humrep/dead152 -
IScience Aug 2023Embryo development after fertilization is largely determined by the oocyte quality, which is in turn dependent on the competence of both the cytoplasm and nucleus. Here,...
Embryo development after fertilization is largely determined by the oocyte quality, which is in turn dependent on the competence of both the cytoplasm and nucleus. Here, to improve the efficiency of embryo development from developmentally incompetent oocytes, we performed spindle-chromosome complex transfer (ST) between matured (IVM) and matured (IVO) oocytes of the non-human primate rhesus monkey. We observed that the blastocyst rate of embryos derived from transferring the spindle-chromosome complex (SCC) of IVM oocytes into enucleated IVO oocytes was comparable with that of embryos derived from IVO oocytes. After transferring the reconstructed embryos into the uterus of surrogate mothers, two live rhesus monkeys were obtained, indicating that the nuclei of IVM oocytes support both the pre-and post-implantation embryo development of non-human primates.
PubMed: 37520712
DOI: 10.1016/j.isci.2023.107299 -
The Journal of Pediatrics Dec 2023To assess serial myocardial performance and pulmonary vascular resistance (PVR) in infants of mothers with gestational diabetes mellitus (GDM) over the first year of... (Observational Study)
Observational Study
OBJECTIVE
To assess serial myocardial performance and pulmonary vascular resistance (PVR) in infants of mothers with gestational diabetes mellitus (GDM) over the first year of life.
STUDY DESIGN
This was a prospective, observational study. Echocardiography was performed at birth, 6 months, and 1 year of age. Pulmonary artery acceleration time and left ventricular (LV) eccentricity index provided surrogate measurements of PVR. Biventricular function was assessed by tissue Doppler imaging and deformation analysis.
RESULTS
Fifty infants of mothers with GDM were compared with 50 controls with no difference in gestation (38.9 ± 0.8 weeks vs 39.3 ± 0.9 weeks; P = .05) or birthweight (3.55 ± 0.49 kg vs 3.56 ± 0.41 kg; P = .95). At 1 year of age, the pulmonary artery acceleration time was lower (70 ± 11 vs 79 ± 10; P = .01) in the GDM group. LV global longitudinal strain (24.7 ± 1.9 vs 28.8 ± 1.8 %; P < .01), LV systolic strain rate (1.8 ± 0.2 vs 2.1 ± 0.3 1/s; P < .01), and RV free wall strain (31.1 ± 4.8 vs 34.6 ± 3.9 %; P < .01) were lower in the GDM cohort at 1 year of age (all P values adjusted for gestation, mode of delivery, and maternal body mass index).
CONCLUSIONS
Our findings demonstrate higher indices of PVR and lower biventricular function in infants of mothers with GDM compared with controls at each time point assessed in this study over the first year of life.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Infant; Diabetes, Gestational; Prospective Studies; Echocardiography; Myocardium; Systole; Gestational Age
PubMed: 37517648
DOI: 10.1016/j.jpeds.2023.113645 -
Reproductive Biomedicine Online Oct 2023How did Danish permanently infertile couples experience surrogacy when going abroad and what impact did the war in Ukraine and the COVID-19 pandemic have on this?
RESEARCH QUESTION
How did Danish permanently infertile couples experience surrogacy when going abroad and what impact did the war in Ukraine and the COVID-19 pandemic have on this?
DESIGN
A qualitative study was performed between May and September 2022. The in-depth semi-structured interviews were conducted with 14 permanently infertile couples across Denmark who were in different stages of using surrogacy. The interviews were transcribed and analysed using systematic text condensation.
RESULTS
All except one couple went abroad, mainly to Ukraine, to have an enforceable transparent contract, professionals to advise them and the possibility of using the eggs of the intended mother. They did not feel that this was a 'choice' but rather the only option they had to have the longed-for child. According to current Danish legislation, the intended mother could not obtain legal motherhood over the child, not even through stepchild adoption, and this increased the feeling of not being a 'worthy mother'. This study expanded on the term 'reproductive exile' by identifying four different forms of exile: the exiled Danish couple, the gestational carrier in exile, exile at home and, finally, the reproductive body in exile.
CONCLUSIONS
Understanding infertile couples' experiences when crossing borders is important for several reasons. It may, among others, assist politicians and authorities in developing a sound Danish legal policy on surrogacy to address the current issues of legal parenthood and avoid missing reproductive opportunities for permanently infertile couples.
Topics: Female; Humans; Pregnancy; COVID-19; Denmark; Infertility; Mothers; Pandemics; Surrogate Mothers; Ukraine; Male
PubMed: 37517186
DOI: 10.1016/j.rbmo.2023.06.013 -
Bioethics Jul 2023Assisted reproduction often involves biological contributions by third parties such as egg/sperm donors, mitochondrial DNA donors, and surrogate mothers. However, these...
Assisted reproduction often involves biological contributions by third parties such as egg/sperm donors, mitochondrial DNA donors, and surrogate mothers. However, these arrangements are also characterised by a biological relationship between the child and at least one intending parent. For example, one or both intending parents might use their own eggs/sperm in surrogacy, or an intending mother might conceive using donor sperm or gestate a donor embryo. What happens when this relationship is absent, as in the case of 'double-donor surrogacy' arrangements (DDS)? Here, a child is conceived using both donor eggs and sperm, carried by a surrogate, and raised by the commissioning parents. In this paper, I critically examine proposals to allow DDS in the United Kingdom, and the intentionalist justification for treating this practice distinctly (morally and legally speaking) from private adoption. I argue that the intentionalist approach cannot plausibly justify such a distinction and that other approaches to moral parenthood are also unlikely to succeed.
PubMed: 37467043
DOI: 10.1111/bioe.13204 -
Philosophy, Ethics, and Humanities in... Jul 2023Comprehensive commercial surrogacy became legal in India in 2002, and many foreigners, including individuals and same-sex couples, sought Indian surrogacy services due...
BACKGROUND
Comprehensive commercial surrogacy became legal in India in 2002, and many foreigners, including individuals and same-sex couples, sought Indian surrogacy services due to their affordability. Numerous scandals resulted, with increasing calls for the government to eliminate the exploitation of women in lower social strata. In 2015, the Indian government decided to exclude foreign clients and commercial surrogacy remained legal for local Indian couples only. Furthermore, to eliminate exploitation, the concept of altruistic surrogacy was introduced in 2016. In 2020, some restrictions within altruistic surrogacy practice were removed. Controversy remains, however, in various sectors, not least because surrogacy is a relatively new concept in India. In this paper, the advantages and disadvantages of both altruistic and commercial surrogacy in the Indian context are considered, and more appropriate policy concerning surrogacy practices is suggested.
METHODS
This paper is based on fieldwork conducted in India from 2010 to 2018. Interview surveys were conducted among doctors, policy makers, activists, former surrogates, and brokers. Government documents and media reports were also important sources.
RESULTS
Surrogacy for commercial purposes began in India in 2002, and stakeholders within the commercial surrogacy industry became well established. It was found that such stakeholders were strongly opposed to altruistic surrogacy as introduced in 2016. It was also found that women in lower social strata still sought some form of financial compensation from their reproductive labor. Controversies surrounding altruistic surrogacy continue within Indian society.
CONCLUSION
Policies and practices aimed at eliminating exploitive need to consider the Indian context carefully. Any surrogacy practice might potentially be exploitive, and the distinction between commercial and altruistic surrogacy is too simplistic to be useful, with more nuanced understanding required. It is of critical importance that investigation continues on how to eliminate the exploitation of Indian surrogate mothers throughout the process, regardless of monetary compensation. The entire surrogacy process should be managed with sensitivity, particularly in relation to the well-being of the mother and child.
Topics: Female; Humans; Pregnancy; Altruism; India; Policy; Reproduction; Surrogate Mothers
PubMed: 37420245
DOI: 10.1186/s13010-023-00130-y