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   Duke Medical Ethics Journal   

Spring 2023 Blog Highlights
Annie Vila  •  Februrary 27

"The first paid surrogacy transaction occurred in 1978. Since then, there has been a steady rise in the use of surrogacy because it has been a viable option for countless couples who cannot conceive without intervention. Despite state laws varying by severity of surrogacy restrictions,1 there are several safe and reliable surrogacy agencies and options both in and out of the U.S. In fact, the global surrogacy market was valued at USD 179.9 million in 2022.2 But, when the demand for trustworthy and affordable surrogacy options increases so greatly, the supply falls behind.."

Catie Fristoe  •  Februrary 27

"In a country already facing countless numbers of health disparities and setbacks, women, especially mothers, have been struck once again. ABC7 describes the Taliban as a “Deobandi Islamic fundamentalist and Pashtun nationalist militant political movement”, a group that was formed in 1994, overthrown after the U.S’s invasion in 2001, and then reinstated in August of 2021. The Taliban are known to have severely restricted women’s human rights when they were in full power about two decades ago, but many had hoped that this time they would be less controlling and less powerful. But their most recently imposed restriction was on the purchasing and selling of condoms and many other forms of birth control within at least two Afghanistan cities, Kabul and Mazar-e-Sharif (ABC7)..."

Morgan Robinson •  February 28

"In the past decade, the numbers of international adoptions have skyrocketed with over 1,700 matches in the U.S. in 2021 [1]. With this influx of overseas adoption, there has been more research into the management of the system and its overlooked flaws. Adoption itself is complex, but adding an international barrier makes the potential drawbacks even more extreme, and new research has called the ethical aspects of the system into question. Some of these issues include unsanctioned agencies that acquire children through unethical processes, economic concerns, and a frightening lack of candor throughout the process..."

Olivia Kim •  March 7

"Prior to the Supreme Court ruling on the case of Dobbs v. Jackson Women’s Health Organization in 2020, Stanford University found that half of medical schools provided either no training on abortions or only a single lecture.1 Since the ruling has resulted in further restrictions on abortion procedures among many states, fewer medical students and residents have access to comprehensive education on the procedure.

OB/GYNs provide the most abortions in the U.S., followed by family medicine physicians.1 The American College of Obstetricians and Gynecologists recommends that all obstetrics and gynecology residency programs include opt-in/opt-out abortion training and include education on abortions in all medical school curricula.2 Beyond simply recommendations, the Accreditation Council for Graduate Medical Education, the entity that accredits Graduate Medical Education programs, requires that all OB/GYN training programs offer their residents access to abortion training.3 This means that many programs must send their residents out of state borders to receive the necessary training in their professions..."

Simone Nabors • March 7

"It is estimated that 1 in 7 birthing people will develop postpartum depression (PPD). While recognizing and treating PPD is important in perinatal mental health care, it isn’t the only diagnosis that needs to be addressed. There are many conditions that may affect people during and around pregnancy including depression, anxiety disorders, and psychosis. In recent years, discussions around PPD have become more common, but major barriers still exist for pregnant people seeking mental health care. To address these barriers, we must reduce the stigma, adequately train providers, and make mental health care more accessible..."

Tomi Oderinde •  March 7

"Despite Black Americans making up 13.6% of the U.S. population, the maternal mortality rate for non-Hispanic/Latina Black women in 2020 was 55.3 deaths per 100,000 live births—almost three times more than that for non-Hispanic/Latina White women [1]. Unfortunately, during the COVID-19 pandemic, the Black maternal mortality rate increased to 68.9 deaths per 100,000 live births in 2021, a much larger mortality rate increase than for non-Hispanic/Latina White women [2]. As a Black woman who wants to have children someday, these statistics terrify me, and I believe that we should not be complacent in accepting this disproportionate mortality rate as the norm. More needs to be done to address the social determinants of health that lead to racial disparities in maternal healthcare, and more needs to be done to protect Black mothers..."

Anna Chen •  March 7

"While the decision to get pregnant and have a child is a decision that is often carefully thought over, for some that option is taken away. Infertility affects millions of people of reproductive age, with some estimates suggesting that between 48 million couples and 186 million individuals are affected globally (WHO). The causes for this condition vary, with most being traced back to abnormalities in sperm, the ovaries, uterus, fallopian tubes, and the endocrine system.


However, there are a variety of options for those looking for treatment. These treatments can depend on multiple factors, including the cause, how long an individual has been infertile, age, as well as personal preferences. One treatment is the use of assisted reproductive technology, with the most common technique being in vitro fertilization (IVF). IVF involves “stimulating and retrieving multiple mature eggs, fertilizing them with sperm in a dish in a lab, and implanting the embryos in the uterus several days after fertilization” (Mayo Clinic). Other options include artificial insemination, in which sperm is transferred directly into someone’s uterus, and ovulation induction, where hormone medication is used to stimulate the ovaries to produce multiple mature follicles and ova..."

Annie Vila •  April 1

"About a third of all infants delivered in the U.S. are delivered via a cesarean section, as opposed to a vaginal birth. This is much lower than the “necessary” rate of c-sections, as the World Health Organization reports this value to be closer to 10-15%[1]. This is troubling, as a vaginal birth is considered the safer option for a healthy pregnancy. So why are there so many c-sections being performed if they are not necessary and not the safer option?

There are ongoing debates as to why the rate of cesarean deliveries continues to rise, but the most probable answer includes a combination of several factors. Increased maternal age and increased numbers of multiple births both play a role in this[2]. Unfortunately, there are much more cynical reasons that could be behind this. Doctors are paid substantially higher for c-sections than they are for natural births. Additionally, c-sections typically take a lot less time than a vaginal birth. One concerned mother who was forced to have a cesarean delivery after her doctors denied her the chance to discuss other birth options, stated that she gave birth right around the holidays and she could tell everyone was itching to go home[3]. Did her doctors perform an unnecessary, and possibly more harmful procedure, with a longer recovery time in order to ensure they made it home earlier for the holidays? This is a truly unsettling and disturbing thought, but it may just be reality..."

Laura Wang •  April 1

"In gestational surrogacy, the surrogate is an individual who did not provide the egg for contraception and who carries the fetus and gives birth to a child for another individual or couple. In the US, the frequency of gestational surrogacies has increased from 738 births in 2004 to 2807 births in 2015 by a gestational surrogate (1). Gestational surrogacy has provided individuals with infertility, single individuals, and LGBTQ individuals with an additional option for parenthood. However, the surrogacy process and current legal regulations in the US bring about several ethical considerations for the intended parents and the surrogate..."

Meera Patel •  April 1

"Seventy-two years ago, a poor black woman walked into a hospital in Baltimore looking for treatment for her vaginal bleeding. When doctors examined her, they found a malignant tumor on her cervix. She was subjected to biopsies and treated with radiation that burned her skin off. Several decades later, the cells from her biopsy–the now infamous HeLa cells– were used for the discovery of medical advancements that made billions of dollars. The woman, Henrietta Lacks, and her legacy, were condemned to a single line in history books, forgotten by the physicians who treated her and forgotten by medicine..."

Eric Wang •  April 1

"Every year, thousands of migrants are detained at the US-Mexico border, of which a small proportion are pregnant women. However, this proportion has significantly increased throughout the past decade and continues to be a significant problem today. The U.S. Immigration and Customs Enforcement (ICE) and Removal Operations reported that pregnant women accounted for roughly 0.3% of all detainees (965 detainees) in 2008, which had risen to roughly 0.4% (1377 detainees) and 0.5% (2094 detainees) in 2016 and 2018, respectively. Although these proportions may not be very large, the sheer number of mothers affected is cause for concern. Furthermore, investigations have found evidence of frequent mistreatment and abuse in ICE detention centers and U.S. Immigration Facilities, leading to miscarriages, adverse birth outcomes, and serious physical and mental impacts on the mothers (Immigration Detention: Care of Pregnant Women in DHS Facilities, 2021)..."

Morgan Robinson •  April 4

"Imagine a world in which humans could manipulate embryo DNA to prevent disease. Every parent could guarantee that their child would be born as healthy as possible. While it may sound too good to be true, recent genetic technology has turned this far-fetched idea into a reality and has sparked debate regarding the ethics of this novel technology.

With tremendous development in the field of genetics, scientists have enhanced their knowledge on manipulation of the human genome. CRISPR/Cas9 is a new technology that edits genes by precisely cutting DNA and either disrupting, deleting, or correcting and inserting new DNA into a target position (1). In embryos, this technique could be used to target genes associated with disease and correct them in order to create a healthier embryo..."

Kidest Wolde •  April 4

"Maternal mental health is a critical aspect of pregnancy and birth that can often be overlooked. While the birth of a child is a momentous occasion, it can also be a challenging time for many mothers. In fact, the World Health Organization estimates that approximately 10% of pregnant women and 13% of women post-birth experience a mental disorder. These disorders can have a significant impact on a mother's well-being, as well as the development and health of her child[8]..."

Camile Krejdovsky •  April 4

"In the realm of reproductive health and genetics, much attention has been given to the possibility of new advances that would allow for editing of the germline to create what has become known as “designer babies”. What has garnered less attention is a practice that is currently undertaken in every US state: newborn screening for genetic disorders. While these newborn screening programs are not new, there are advances on the horizon that warrant consideration, such as a shift from targeted testing centered around specific genes to genome wide testing. Even within the current programs that screen for a limited number of conditions, there exist ongoing ethical considerations that must be addressed..."

Caroline Metz  •  April 4

"Following the overturn of Roe V. Wade, CVS stores across the United States placed a purchasing cap on “Morning After Pills,” more commonly known as “Plan B,” in hopes of ensuring equitable access to all who wanted to purchase. Though no purchasing cap was placed on Plan B in Walgreens stores, representatives claimed that they may enforce a limit if they see an influx of purchasing. Many fear that with the overturn of Roe V. Wade, bulk-purchasing of Plan B could cause shortages, greatly impacting those who need it most.

Without an ID or prescription, emergency contraceptive pills can be purchased over-the-counter, whereas abortion medications require a prescription and strict pill regimen. Commonly used after unprotected sex, Plan B and similar contraceptives can prevent the release of an egg from the ovary. Plan B is not accessible to all, however. With an average price of around $50, these tiny pills could be too expensive for those who need it, placing it out of reach for some consumers..."

Marshlee  Eugene  •  April 10

"In 1970, Jane Roe filed a lawsuit against Henry Wade, the district attorney of Dallas County, Texas, to challenge a Texas law that banned abortion unless it was a life saving measure used by doctors. This case eventually made its way to the Supreme Court. On January 22, 1973, the Supreme Court passed a landmark decision in the case known as Roe v. Wade. Justice Harry Blackmun delivered the opinion for the 7-2 majority vote, and it was decided that a woman's right to an abortion was protected under the 14th amendment, and that states could only pass laws to regulated abortions received during the second and third trimester of pregnancy.

Under President Donald Trump, senators worked hard to ensure that various republican and notably anti-abortion people were appointed to judicial vacancies. Between 2016 and 2020, three new Supreme Court justices were appointed, who were known to be hostile to reproductive rights. Before Roe v. Wade was overturned, it had been leaked that the Supreme Court had intentions to do so. On Friday, June 24, 2022, the United States Supreme Court overturned Roe v. Wade in a case called Dobbs v. Jackson Women’s Health Organization, which was filed to contest a law that banned abortion after 15 weeks of pregnancy in Mississippi. Thirteen states in the USA had trigger ban abortion laws in place that would take effect almost immediately if Roe was ever overturned, which included fining and/or charging (with a felony) people seeking an abortion in the state the ban was passed..."

Abby Cortez •  April 10

If you ask anyone what they know about biology, at least one of the things they say is probably going to be: “the mitochondria is the powerhouse of the cell.” But what does that actually mean? And what happens if the powerhouse shuts down?

The mitochondria is a type of organelle, a word which refers to things contained within human cells, and it produces the energy (in the form of ATP, Adenosine Triphosphate) needed for the body to function. The mitochondria is special because it has its own DNA separate from the DNA in the nucleus of the cell that makes up most of our genetics. This DNA is crucial for the function of the mitochondria and this the function of the body..."

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