Tuesday, August 10, 2021
By Kelly Folkers (Aug. 10, 2021)
As the COVID-19 pandemic continues, increasing numbers of patients are seeking care through telemedicine, allowing them to communicate with their doctors and be prescribed medicines without leaving home. Access to abortion medication is a part of this trend, with more pregnant people seeking to terminate early pregnancies by requesting access to medication they can self-administer at home. Despite the FDA’s decision earlier this year not to enforce a previous requirement that abortion medications be administered in person, access to medication-induced abortion remains vastly inequitable as conservative state legislatures target the practice.
Current Food and Drug Administration (FDA) regulations on abortion medication officially require that the first dose be administered in a healthcare setting or under the supervision of a provider specifically certified to prescribe the medication. In 2020, the ACLU filed a lawsuit on behalf of the American College of Obstetricians and Gynecologists (ACOG) challenging the in-person dispensing requirement, which resulted in a nationwide injunction preventing the FDA from enforcing the rule. But the Supreme Court lifted the injunction in January 2021 and held, in a 6-3 decision, that the district court should have deferred to the FDA’s expertise, avoiding the question of whether the rule imposed an undue burden on the constitutional right to abortion. After President Biden took office, the FDA announced in April 2021 that it would not enforce the in-person dispensing requirement for the duration of the COVID-19 pandemic.
The agency is now considering permanently removing the in-person dispensing requirement. But as access to abortion hangs in a precarious balance as the Supreme Court prepares to hear a direct challenge to Roe v. Wade later this year, have passed laws in 2021 targeting medication-induced abortions.
There are two types of abortion: surgical and medication. While a surgical abortion is a medical procedure that must be performed in a clinic or medical office, the procedure for most medication-induced abortions requires that patients take two medicines, mifepristone and misoprostol, at least 24 hours apart, respectively. ACOG has stated in its most recent guidance on medication-induced abortions, that patients can safely and effectively take abortion medications at home. But the FDA issued a Risk Evaluation and Mitigation Strategy (REMS) for mifepristone when it was approved in 2000, requiring that the medication be ordered, prescribed, and dispensed under the supervision of a health care provider who is specifically certified to administer it. The agency issues REMS to “reinforce medication use behaviors and actions that support safe use of that medication.” While there have been some reported adverse events, including a handful of deaths, associated with use of mifepristone, the medication is widely considered to be safe and effective, with over 3.7 million patients having been prescribed the drug since its approval.
Though the FDA announced that it would not be enforcing the REMS on mifepristone during the pandemic, even before the pandemic, the restriction had long frustrated abortion rights advocates, who believe it is too restrictive and politically motivated. In 2019, former FDA Commissioner Dr. Jane Henney argued in the New England Journal of Medicine that the restrictions on distribution of mifepristone made at its approval in 2000, before the drug was widely used and in the United States and additional safety and efficacy data collected, may no longer be appropriate.
Despite ACOG’s assertion that the in-person dispensing requirement has no medical benefit for patients, conservative state legislatures have used the Supreme Court’s decision to target medication-induced abortions. Montana has effectively banned telehealth for abortion. Ohio has a similar law in effect, which is being challenged by Planned Parenthood and other advocacy groups in court. Indiana not only required that the first dose of medication be administered in the presence of a healthcare professional, patients must be advised that their abortions can be reversed with progesterone, which is not scientifically supported. The law has since been blocked by a federal judge. At least 20 states prevent telemedicine appointments for abortion pill prescriptions, and more than 30 require that physicians must write the prescriptions, rather than nurse practitioners or physician assistants who are otherwise able to prescribe medication.
Though laws limiting access to medication-induced abortion continue to threaten reproductive rights, there is hope that under the new Democratic Administration, the FDA will end the restrictive in-person dispensing requirement.
Tuesday, August 3, 2021
By Fallon Parker (Aug. 3, 2021)
Last week marked the 31st anniversary of the Americans with Disabilities Act (ADA), which seeks to affirm and protect the rights of people with disabilities. Among other provisions, the act guarantees equal opportunity to person with disabilities in employment, transportation, services, accommodations, and other areas. While the ADA has resulted in significant changes for the disabled community, persons with disabilities who use reproductive healthcare still struggle to gain access to services.
Disability rights and reproductive justice have always been closely linked. Buck v. Bell, which has not been overturned, allowed for sterilization of institutionalized persons in order to benefit the “welfare of society.” Eugenics, which was espoused as a way to “improve society” and specifically targeted disabled persons, among other marginalized groups, motivated some early supporters of birth control.
Today, it is recognized that persons with disabilities have the same reproductive and sexual health needs as persons without disabilities, and yet studies show that persons with disabilities do not access reproductive care at the same rates as their peers. According to the National Council on Disability, disabled persons reported avoiding regular gynecological visits because they were difficult to obtain, and that healthcare workers often refrained from discussing contraceptives or STD screening with disabled persons and expressed surprise to learn disabled persons were sexually active. Persons with disabilities are also likely to have fewer pap tests and mammograms than persons without disabilities. Additionally, disabled persons are poorer on average than non-disabled persons, and income is directly related to ability to access reproductive services. And some disabled persons who rely on Medicaid do not have access to insurance coverage for abortion services.
Recently there has been an influx of attention to the intersection of disability rights and the reproductive justice movement. Britney Spears, the singer who has been under a conservatorship for 13 years, finally had her day in court and revealed, among other things, that her conservatorship forces her to wear an IUD. While the exact terms and genesis of the conservatorship are not public, it reportedly followed an involuntary temporary psychiatric hold filed on her 13 years ago based on an assessment that she was a possible danger to herself or others.
This year, Spears expressed to a court her desire to have more children and her frustration with not having any control over that decision. In response to Spears’s testimony, several websites have published accounts from disabled persons noting the similarities between Spears’s lack of bodily autonomy and the restrictions that disabled persons face daily. Sara Luterman, a journalist who is disabled, was interviewed for Slate and broke down how difficult it is for people to remove themselves from a conservatorship or guardianship. Luterman mentioned Ryan King, a man with an intellectual disability who could not remove his conservatorship, even though his conservators, who were his parents, asked the court to remove it. Like it is for King, Luterman fears it will be difficult for Spears to remove herself from her conservatorship.
Spears’s conservatorship and her fight for bodily autonomy highlight a common reality for many disabled persons, especially those with reproductive needs. While the ADA was a significant moment in the fight for disability rights, it has fallen short in providing reproductive justice for disabled persons. Within the mainstream reproductive justice movement, disabled persons are often left out of the conversation. The anniversary of this landmark legislation is an opportunity to reaffirm commitment to the importance of disability rights in the fight for reproductive justice and consider how the next 30 years can be used to ensure equitable access to reproductive healthcare for all.
Wednesday, July 18, 2018
The Washington Post (Jul. 17, 2018): Who gets the embryos? Whoever wants to make them into babies, new law says, by Ariana Eunjung Cha:
New court cases cases are grappling with the decision of what to do with frozen embryos created during a marriage that later dissolves. In many cases that Cha reports on, the couples chose to create and freeze several embryos in the wake of a cancer diagnosis and treatment schedule that threatened later fertility.
When these same couples faced divorce, there were bitter divides over what should be done with the embryos: one party wanted to maintain "ownership" of the embryos for a future chance at children while the other wanted the embryos destroyed, fearing unwanted future financial or relationship obligations.
With the number of frozen embryos in the United States soaring into the millions, disputes over who owns them are also on the rise. Judges have often — but not always — ruled in favor of the person who does not want the embryos used, sometimes ordering them destroyed, following the theory that no one should be forced to become a parent.
In Arizona, though, a "first-in-the-nation law" went into effect on July 1 that states "custody of disputed embryos must be given to the party who intends to help them 'develop to birth.'"
The legislation represents for some lawmakers the idea that frozen embryos have their own right to life, and many imagine that the implications could eventually include a delineation of when life begins and a claim to a separate set of embryonic rights of their own as human beings (rather than the discussion being centered on who "owns" the embryos).
Some groups, like the anti-abortion Thomas More Society, advocate for that embryos to be considered "children" in the legal sense, asking judges to make decisions on disputes based on the best interest of the "child."
Debates to extend personhood to unborn embryos and fetuses abound in anti-abortion work. Abortion rights advocates are concerned that these discussions could further disintegrate the right to abortion in the United States. "If a days-old embryo in a freezer has a right to life, why not a days-old embryo in utero?"
While judges have historically ordered disputed embryos destroyed based on the wishes of the party who does not want a child, an Arizona judge chose to balance one party's "probable inability to have a child without the embryos" against the other party's "desire to not be a father" a different way.
Maricopa County Superior Court Judge Ronee Korbin Steiner held that Ruby Torres, who wanted the embryos in order to have biological children one day, had no right to them. The judge did not order them destroyed, though, and instead ordered that they go up for donation.
Torres appealed the decision and expects a new ruling any day.
The new Arizona law that states embryos shall be given to the party who intends to develop them to birth was written in response to this case to "help" people in Torres' situation. It also attempts to recognize the rights of those who do not want the embryos used by providing that those parties would not be liable for child support in the future.
Both the judicial decisions and the legislation continue to prove extremely controversial:
The Center for Arizona Policy, a conservative lobbying group that has successfully pushed antiabortion legislation in the state, supported the measure, saying the bill would “lead to more consistent rulings.”
The American Society for Reproductive Medicine, which represents doctors, nurses and other professionals who work on fertility issues, opposed the measure, arguing that it would have a profound impact on reproductive medicine.
Medical professionals foresee profound complications to stem-cell research in particular, which relies on embryos donated to science. Such research is believed essential in developing treatments for many diseases and conditions like Parkinson's and Alzheimer's. The treatment and storage of embryos as a result of the new legislation will likely make embryonic stem cells much more scarce.
In a friend-of-the-court brief in Torres' pending appellate case, the Academy of Adoption and Assisted Reproduction Attorneys urged judges in the Arizona Court of Appeals to balance the interest of each former spouse. They argue that the parties claims are not equal and that "the constitutional protection against compulsory parenthood is [generally] greater than any procreative interest in pre-embryos."
Time will tell both if the appellate judges affirm Judge Steiner's controversial ruling (likely leading to further appeals) while we also wait for the inevitable challenges to Arizona's new embryo law.
July 18, 2018 in Abortion, Assisted Reproduction, Bioethics, Culture, Current Affairs, Fertility, Fetal Rights, In the Courts, Medical News, Parenthood, Politics, Public Opinion, Scholarship and Research, State and Local News, State Legislatures, Stem Cell Research | Permalink | Comments (0)
Tuesday, March 14, 2017
New York Times (Feb. 15, 2017): Human Gene Editing Receives Key Panel's Support, by Amy Harmon:
In a move that some fear heralds the era of designer babies for the very wealthy and that has led other countries to ban germ line genetic editing, a panel of influential American scientists has thrown its support behind inheritable modifications of human embryos. Although touted as a way to cure disease, many see the potential for this science to be used for more nefarious motives--enhancing mental or physical endowments, for example--that smack of eugenics.
The research is explicitly aimed at allowing parents who both carry deadly recessive traits to have children who are not afflicted by such diseases as Tay-Sachs, beta thalassemia, and Huntington's. The report calls for prohibitions on using the technology for enhancements, but it does not have any legal effect. Federal law, though, currently prohibits the use of "federal money to support research that results in genetically modified offspring."
The issue arises on the heels of technology--Crispr-Cas9--that brings germ-line genetic editing out of the realm of science fiction. The tool allows researchers to insert and delete genes more or less precisely, although the possibility remains that some DNA will be snipped off inadvertently. They will experiment first on patients with cancer and blindness using genetic alterations that are not inheritable.
Friday, July 15, 2016
New York Magazine (July 7, 2016): Why Do We Treat Sexually Abusive Doctors Differently Than Other Predators?, by Susan Rinkunas
Linking to a study done by the Atlanta Journal Constitution, this article and the study explores the safe space that doctors create with patients, and the physicians that violate that safe space with unwarranted sexual harassment or assault. For many women seeking reproductive - or other types of - healthcare, it is more confusing when doctors cross a line because of the power they hold, the space they share with patients, and the inherent vulnerability of being in an exam room with someone who has vowed to "do no harm." The medical profession also seems to look the other way when when people are courageous enough to step forward and report these offenders:
Medical boards do publicly reprimand doctors, with sanctions including treatment programs, required chaperones when seeing female patients, and monitoring of their practice. Still, the reporters found that, of 2,400 doctors publicly disciplined for sexual misconduct nationwide since 1999, half still had active medical licenses. Some doctors who lost their licenses simply applied for one in another state.
The report raises the question: Why are some doctors seemingly given a pass while abusive coaches, teachers, and, more recently, priests get registered as sex offenders?
Tuesday, October 20, 2015
New York Times (Oct. 16, 2015): Egg Donors Challenge Pay Rates, by Tamar Lewin:
In a federal lawsuit, a group of women are challenging [infertility] industry guidelines that say it is “inappropriate” to pay a woman more than $10,000 for her eggs. The women say the $10,000 limit amounts to illegal price-fixing, and point out that there is no price restriction on the sale of human sperm. A federal judge has certified the claim as a class action.
The crux of the lawsuit is the allegation that infertility clinics have set the price of egg donor services at a low, non-competitive level, in a move that draws infertile couples to infertility clinics. The industry has responded that the guideline aims to protect egg donors and recipients, an arguably procompetitive motive. But as Kimberly Krawiec has pointed out, the evidence in the case seems to point the other way: egg donors could command higher prices in the open market. A cap on the price they can charge diminishes their power in the marketplace.
The lawsuit will likely go to trial next year.
Wednesday, October 14, 2015
The Hill (Oct. 13, 2015): Planned Parenthood Stops Taking Money for Fetal Tissue Donation, by Sarah Ferris:
Planned Parenthood's president Cecile Richards wrote a letter to the National Institutes of Health stating that the organization will no longer be accepting reimbursement for its fetal tissue donation program.
“This new policy removes beyond the shadow of a doubt the ludicrous idea that Planned Parenthood has any financial interest in tissue donation — and shows the real agenda behind these attacks,” Richards wrote in a statement.
Wednesday, March 4, 2015
The Guardian: Britain's House of Lords approves conception of three person babies, by Hannah Devlin:
Britain has become the first country in the world to permit the use of “three-person IVF” to prevent incurable genetic diseases.
The House of Lords voted by 280 votes to 48 on Tuesday evening to approve changes to the law allowing fertility clinics to carry out mitochondrial donation. Babies conceived through this IVF technique would have biological material from three different people – a mother, father and a female donor. . . .
Technically the baby would have three biological parents, with 99.8% of genetic material coming from the mother and father and 0.2% coming from the mitochondrial donor. . . .
PBS: Why the term 'three-person baby' makes doctors wince, by Rebecca Johnson:
MELAS is one of about 200 known mitochondrial diseases, a subject that has featured prominently in the news since the British Parliament’s House of Commons on Feb. 3 approved further testing and research on mitochondrial replacement IVF. The procedure has beencommonly referred to in news stories as “three-person babies” or “three-parent babies.”
But it’s a term that makes doctors wince. . . .
Friday, March 21, 2014
New technology would enable women who carry harmful mutations in their mitochondria to have a child without those harmful mutations. Despite concerns, that's a good thing.
Since January, a new California law allows for a child to have more than two legal parents. But children are still limited to two genetic parents. That could change soon, if the Food and Drug Administration approves human clinical trials for a technique known as mitochondrial replacement, which would enable a child to inherit DNA from three parents.
News of the pending application has caused a kind of panic not seen since Dolly the sheep was cloned, raising the possibility of a single genetic parent. But far from being the end of the human race as we know it, the technique might be a way to prevent hundreds of mitochondrial-linked diseases, which affect about one in 5,000 people. . . .
Saturday, March 1, 2014
The Los Angeles Times: Study calls DNA test reliable in discovering fetal disorders, by Monte Morin:
The screening more accurately identifies likely cases of genetic disorders caused by extra chromosomes, like Down syndrome, in a study of low-risk pregnant women.
It's billed as a faster, safer and more accurate way of screening expectant mothers for fetal abnormalities like Down syndrome, and proponents say it has already become the standard for prenatal care.
But as a handful of California companies market their DNA-testing services to a growing number of pregnant women, some experts complain that the tests have not been proven effective in the kind of rigorous clinical trials that are required of new drugs.
Now, a study published Wednesday by the prestigious New England Journal of Medicine has verified that one of the tests can identify likely cases of Down syndrome and other genetic disorders caused by extra chromosomes in low-risk women with greater reliability than traditional noninvasive screening methods. . . .
Wednesday, February 26, 2014
USA Today: FDA raises concerns about three-parent embryo procedure, by Karen Weintraub:
In two days of hearings ending Wednesday, a federal committee proved quite skeptical about research that might help some patients birth healthy children — but might also open the door to human gene manipulation.
The procedure being considered, called mitochondrial transfer, would mix the genes of two women in hopes of creating a healthy baby. . . .
WebMD: FDA Explores '3-Person' Embryo Fertilization, by Dennis Thompson:
U.S. Food and Drug Administration hearings opened Tuesday on a controversial fertilization technique that uses the DNA from three people -- two women and one man -- with the goal of preventing inherited genetic diseases. . . .
Wednesday, February 5, 2014
Reuters: Brain-dead Canadian woman kept on life support to save fetus, by Julie Gordon:
A 32-year-old Canadian woman who has been declared brain dead is being kept on life support in a Victoria, British Columbia hospital, with doctors working to keep her alive long enough to deliver her unborn son. . . .
The New York Times: Ethics Questions Arise as Genetic Testing of Embryos Increases, by Gina Kolata:
. . . Genetic testing of embryos has been around for more than a decade, but its use has soared in recent years as methods have improved and more disease-causing genes have been discovered. The in vitro fertilization and testing are expensive — typically about $20,000 — but they make it possible for couples to ensure that their children will not inherit a faulty gene and to avoid the difficult choice of whether to abort a pregnancy if testing of a fetus detects a genetic problem.
But the procedure also raises unsettling ethical questions that trouble advocates for the disabled and have left some doctors struggling with what they should tell their patients. . . .
Friday, September 20, 2013
The Guardian (op-ed): Why women have a right to sex-selective abortion, by Sarah Ditum:
As far as I'm concerned, it doesn't matter why any woman wants to end her pregnancy. If it's to select for sex, that's her choice
When you talk about being pro-choice, sex selective abortion is often slung at you as the triumphant gotcha. "You love women so much you want them to be in charge of what grows inside their bodies, but what about the women who are aborted, have a go at answering that? ZING!"
The answer is actually remarkably simple, and it's this: it doesn't matter whether what's growing inside you is liable to end up as a man or a woman. What matters is whether the person it's growing inside – the person who is going to have to deliver the resulting baby, at not inconsiderable personal peril – actually wants to be pregnant and give birth to this child. . . .
Saturday, August 17, 2013
Pew Research - Religion & Public Life Project: Abortion Viewed in Moral Terms: Fewer See Stem Cell Research and IVF as Moral Issues:
Regardless of their views about the legality of abortion, most Americans think that having an abortion is a moral issue. By contrast, the public is much less likely to see other issues involving human embryos – such as stem cell research or in vitro fertilization – as a matter of morality. . . .
Lifenews seems somewhat puzzled by the discrepancy:
A new Pew research poll finds Americans say abortion is morally wrong by a 3-1 margin. However, Americas are still divided on the issue of embryonic stem cell research — even though it destroys human life and still has not helped any patients. . . .
But perhaps anti-choice groups themselves are partly to blame:
The Atlantic Wire: Americans See Abortion, But Not Stem Cell Research, as a Moral Issue, by Abby Ohl Heiser:
. . . While the issue is currently framed in "momentum" language familiar to any election horse race aficionado, our views on its legalization overall have stayed pretty steady since Roe v. Wade. . . . So what's momentum got to do with it?
For starters, the far-right legislative push to pass a series of abortion-restricting laws is bringing a cornucopia of moral associations with it, ones that resonate with conservative-leaning politics. . . .
For scholarly analysis of this issue, see my articles The Meaning of 'Life': Belief and Reason in the Abortion Debate and Roe v. Wade's 40th Anniversary: A Moment of Truth for the Anti-Abortion-Rights Movement?
Wednesday, August 7, 2013
The New York Times - op-ed: End of Life, at Birth, by April R. Dworetz:
FIFTY years ago this Wednesday, Americans were gripped by the fate of a baby — Patrick Bouvier Kennedy, the first child born to a sitting president since the 19th century, and John F. Kennedy’s last. He arrived on Aug. 7, 1963, five and a half weeks premature. Despite medical heroics, including the use of a hyperbaric oxygen chamber, he died 39 hours later.
Neonatal care has improved greatly since then. Were he born today, Patrick, who was delivered at 34 weeks’ gestation, would very likely survive and have a healthy life, too.
For all the biomedical advances, though, the key ethical problems surrounding premature birth remain. . . .
H/T: Carol Sanger
Monday, July 15, 2013
The Los Angeles Times - op-ed: Leveling the field for human egg donors, by Naomi Cahn & June Carbone:
A bill before Gov. Jerry Brown would make it legal for research programs to pay for human eggs, as they do for sperm. But the issue is complicated.
In the United States, there is a competitive market in human eggs provided for reproductive purposes. An "extraordinary" egg donor can earn as much as $50,000 when she offers her eggs to an infertile couple. In California, however, that same "extraordinary" individual would receive nothing, aside from payment for her direct expenses, if she provided those same eggs for research purposes. That could change soon. . . .
Friday, June 7, 2013
I. Glenn Cohen and Travis G. Coan (both of Harvard Law School) have posted Can You Buy Sperm Donor Identification? An Experiment. Here is the abstract:
In the United States, most sperm donations are anonymous. By contrast, many developed nations require sperm donors to be identified, typically requiring new sperm (and egg) donors to put identifying information into a registry that is made available to a donor-conceived child once they reach the age of 18. Recently, advocates have pressed U.S. states to adopt these registries as well, and state legislatures have indicated openness to the idea. This study re-lies on a self-selected convenience sample to experimentally examine the economic implications of adopting a mandatory sperm donor identification regime in the U.S. Our results support the hypothesis that subjects in the treatment (non-anonymity) condition need to be paid significantly more, on average, to donate their sperm. When restricting our attention to only those subjects that would ever actually consider donating sperm, we find that individuals in the control condition are willing-to-accept an average of $$43 to donate, while individuals in the treatment group are willing-to-accept an aver-age of $74. These estimates suggest that it would cost roughly $31 per sperm donation, at least in our sample, to require donors to be identified. This price differential roughly corresponds to that of a major U.S. sperm bank that operates both an anonymous and identify release programs in terms of what they pay donors.
Wednesday, March 6, 2013
NBC Connecticut: Surrogate Gives Birth Against Biological Family's Wishes, by Josh Chapin:
The couple offered her $10,000 to have an abortion, but she refused.
When a Vernon woman was hired to be a surrogate in 2011, she never expected that the decision would lead to a more agonizing decision about the fate of a little girl, a battle in the courts and a move out of state so she had the power to make choices about the child's welfare. . . .
NBCNEWS.com - Vitals: $10,000 to abort? Surrogacy case reveals moral holes bioethicist says, by Arthur Caplan:
Crystal Kelley got paid $22,000 to have a baby. But that wasn’t the only offer the 29-year-old Connecticut mother of two received. After an utrasound at 21-weeks revealed significant medical issues, the parents offered her $10,000 more if she agreed to an abortion.
The gross immorality of that second offer tells us that there is a lot wrong with the first arrangement. It is intolerable that our society continues to put up with an unregulated, free market in hiring cash-starved women to make babies. . . .
Washington Post - She The People blog: Surrogate mother refused abortion: Right? Wrong? Damned to hell?, by Aly Neel:
A surrogate mother and the couple that hired her make a painful discovery after an ultrasound: Their unborn child will have serious health problems and will possibly never have a “normal” life.
The biological parents, who say they cannot bring a child into the world to endure so much suffering, offer the surrogate, who is struggling to make ends meet, $10,000 to abort the baby. . . .
Monday, March 4, 2013
WNYC - The Brian Lehrer Show: Ask a Bioethicist: Reproductive Technology:
We begin a series about medical ethics with Duke University bioethicist Nita Farahany, who sits on the Presidential Commission for the Study of Bioethical Issues. Each week, she'll discuss some of the thorniest bioethical conundrums of our day.
Today's topic: Reproductive technology. We want your suggestions of bioethical questions we should discuss. Should parents be able to choose the sex of their baby? Should there be age limitations on people who undergo in vitro fertilization? That kind of thing. Ask your question below and we'll tackle as many as we can.
The show airs on Tuesday, March 5. Submit your question here.