Although a pregnant woman can now refuse any medical treatment needed by the fetus, the Court of Appeal has acknowledged that ethical dilemmas remain, adverting to the inappropriateness of legal compulsion of presumed moral duties in this context. This leaves the impression of an uncomfortable split between the ethics and the law. The notion of a pregnant woman refusing medical treatment needed by the fetus is troubling and it helps little simply to assert that she has a legal (...) right to do so. At the same time, the idea that a pregnant woman fails in her moral duty unless she accepts any recommended treatment or surgery—however great the burdens—is also not without difficulty. This article seeks to find a way between these two somewhat polarized positions by arguing that, instead of being a question primarily about whether legally to enforce moral obligations, the «maternal—fetal conflict» begins with previously unrecognized difficulties in determining when a woman's prima facie moral rights invoked in the treatment context should «give way» to the interests of the fetus. This difficulty is mirrored within the law. Thus, how can we tell when a pregnant woman has the moral or legal duty to submit to a caesarean section? Seen in this way, the conflict is a problem which lies at the interface between moral and legal rights and duties, showing that there are important conceptual links between the ethics and the law. Against this background, this article explores the limits of a pregnant woman's right to bodily integrity by focusing upon the idea of her moral duty to aid the fetus through her body. Here we find difficulties in determining the existence and extent of this somewhat extraordinary duty. Such a duty is contrasted with both negative and positive duties toward others in the course of «general conduct». Attention to the social context of pregnancy and the refusal of treatment within this is also instructive. Overall, the purpose is to foster understanding and acceptance of the current legal position. (shrink)

The pregnant subject has a unique experience of her body. The dichotomy between self and other, self and world, breaks down. She can experience a positive narcissism and sense of process. Some conceptualizations and practices of contemporary medicine, however, can alienate the pregnant subject from this bodily experience. Keywords: Embodiment, Split Subjectivity CiteULike Connotea Del.icio.us What's this?

The introduction of non-invasive prenatal testing in healthcare systems around the world offers an opportunity to reconsider funding policies for prenatal screening. In some countries with universal access healthcare systems, pregnant women and their partners are asked to pay for NIPT. In this paper, we discuss two important rationales for charging women for NIPT: to prevent increased uptake of NIPT and to promote informed choice. First, given the aim of prenatal screening, high or low uptake rates are not intrinsically (...) desirable or undesirable. Using funding policies to negatively affect uptake, however, is at odds with the aim of screening. Furthermore, copayment disproportionally affects those of lower socioeconomic status, which conflicts with justice requirements and impedes equal access to prenatal screening. Second, we argue that although payment models may influence pregnant women’s choice behaviours and perceptions of the relevance of NIPT, the copayment requirement does not necessarily lead to better-informed choices. On the contrary, external influences on women’s personal choices for or against prenatal screening should ideally be avoided. To improve informed decision-making, healthcare systems should instead invest in adequate non-directive, value-focused pretest counselling. This paper concludes that requiring copayments for NIPT in universal access healthcare systems fails to promote reproductive autonomy and is unfair. (shrink)

This article examines the impact that the interplay between workplace, the welfare state and global working life has on female workers when they become pregnant. By focusing on two highly educated Norwegian female workers, it explores how this change process takes place in two companies operating in the global market located in different countries: Norway and the US. Pregnancy contributes to transforming the neutralized bodiless female worker into an embodied worker with gender. The female workers' experiences and negotiations represent (...) forms of global action on local stages. This is illustrated by four processes: `married to work', `pregnant and still married to work', `negotiating separation from work' and `excluding mothering'. The findings indicate the significance of taking welfare state and workplace policy approaches into consideration in studies of global effects on employees. (shrink)

Hospital ehtics committees are often consulted when cmopeting patient interests blur an otherwise clear course of medical treatment. Nowhere is the potential for competing interests greater than in the field of abosterics, wherer obstetricians have traditionally viewed themselves as having two patients: the pregnant woman and the fetus.

ObjectivePregnancy leads to long-lasting changes in brain structure for healthy women; however, little is known regarding alterations in the cortical features of pregnant women with malformed fetuses. Isolated clefts of the lip and/or palate (ICL/P) are the most common congenital anomaly in the craniofacial region, which is highly gene-associated. We speculated that pregnant women carrying fetuses with ICL/P may have associated risk genes and specific brain changes during pregnancy.MethodsIn this study, we investigated T1-weighted brain magnetic resonance imaging data (...) from 48 pregnant women: 24 women carrying fetuses with ICL/P (ICL/P group) and 24 women carrying normal fetuses (normal controls), then explored intergroup differences in gray matter volume (GMV), cortical thickness (CT) and cortical complexity (gyrification).ResultsCompared with controls, the ICL/P group had decreased total intracranial volume (TIV) than normal controls; besides, they exhibited increased GMV in the left cuneus, decreased GMV in the right superior temporal gyrus; increased CT in the left precuneus and left superior parietal gyrus, decreased CT involving parsopercularis, fusiform, middle temporal in the left hemisphere and supramarginal, precentral gyrus (PreCG) in the right hemisphere; increased gyrification in the left insula and PreCG, the left middle temporal, and the right supratemporal gyrus.ConclusionPregnant women with ICL/P fetuses had brain morphology changes involving language, auditory, vision, and sensory cortex, which may be their special brain changes compared to normal pregnant women. This study may provide clues for the early detection of fetuses with ICL/P, and be vital for preconception and prenatal counseling with non-invasive methods. (shrink)

A new study published in Journal of Medical Ethics by van der Zande et al 1 further highlights why classifying pregnant women as a ‘vulnerable population’ in the context of research is deeply problematic. Because the designation of ‘vulnerable’ is otherwise applied to populations whose decision-making capacity about research participation is somehow compromised—such as children and adults of limited cognitive ability—many of us have been arguing for some time that using this designation for pregnant women is inappropriate and (...) disrespectful.2–4 There is nothing about the state of pregnancy that renders pregnant women incapable of offering valid research consents or refusals. Moreover, rather than protecting the health interests of pregnant women and their offspring, this designation has had the opposite effect. It has contributed to the widespread exclusion of pregnant women from research activities, which is itself pernicious to the health of pregnant women.5 We know that pregnant women encounter a range of health needs across their pregnancies. In the USA, for example, approximately 9 out of every 10 women use some kind of medication during pregnancy to manage health conditions.6 Yet because pregnant women have largely been …. (shrink)

Do pregnant mothers have fetuses as parts? According to the “parthood view” they do, while according to the “containment view” they don’t. This paper raises a novel puzzle about pregnancy: if mothers have their fetuses as parts, then wherever there is a pregnant mother, there is also a smaller thinking being that has every part of the mother except for those that overlap with the fetus. This problem resembles a familiar overpopulation puzzle from the personal identity literature, known (...) as the “Thinking Parts Problem”, but it’s not merely a special case of that problem. Rather, the fact that late-term fetuses have a mental life of their own makes the Problem of Pregnant Thinkers, as I will call it, a sui generis and especially recalcitrant problem. (shrink)

In recent years, feminist theorists have examined the use of visual technologies in pregnancy and argued that these technologies are reconstructing the meaning of pregnancy. The imaged body of gestation can be deployed to distinguish and separate maternal and foetal interests. Drawing on this work, ‘Visibly Pregnant: Toward a placental body’ argues that the use of visual technology also obfuscates that which it purports to make clear. The images produced by these technologies in particular do not locate and acknowledge (...) the significance of the placenta as a point of connection and distinction for the gestating body. The possibilities suggested by a concentration on the placenta show how the morphology of the pregnant body itself rejects the distinction outlined in the technologically produced images of pregnancy and offers some new possibilities for thinking subjectivity. (shrink)

Criticisms of the “container” model of pregnancy picturing female and embryo as separate entities multiply in various philosophical and scientific contexts during the last decades. In this paper, we examine how this model underlies received views of pregnancy in evolutionary biology, in the characterization of the transition from oviparity to viviparity in mammals and in the selectionist explanations of pregnancy as an evolutionary strategy. In contrast, recent evo-devo studies on eutherian reproduction, including the role of inflammation and new maternal cell (...) types, gather evidence in favor of considering pregnancy as an evolved relational novelty. Our thesis is that from this perspective we can identify the emergence of a newhistoricalindividual in evolution. In evo-devo, historical units are conceptualized as evolved entities which fulfill two main criteria, their continuous persistence and their non-exchangeability. As pregnancy can be individuated in this way, we contend that pregnant females are historical individuals. We argue that historical individuality differs from, and coexists with, other views of biological individuality as applied to pregnancy (the physiological, the evolutionary and the ecological one), but brings forward an important new insight which might help dissolve misguided conceptions. (shrink)

- Readers learn how to apply alchemical symbols to their lives and interpret dreams and visions.- A clear and practical explanation of spiritual alchemy and how it can be used for transformation.

Reasoning well about risk is most challenging when a woman is pregnant, for patient and doctor alike. During pregnancy, we tend to note the risks of medical interventions without adequately noting those of failing to intervene, yet when it's time to give birth, interventions are seldom questioned, even when they don't work. Meanwhile, outside the clinic, advice given to pregnant women on how to stay healthy in everyday life can seem capricious and overly cautious. This kind of reasoning (...) reflects fear, not evidence. (shrink)

In this article, I explore two neglected works by the twentieth-century Jewish German Marxist philosopher Ernst Bloch, Avicenna and the Aristotelian Left and Natural Law and Human Dignity. Drawing on previous analyses of leftist Aristotelians and natural law, I blend Bloch’s two texts’ concepts of pregnant matter and maternal law into “pregnant materialist natural law.” More precisely, Aristotelian Left articulates a concept of matter as a dynamic, impersonal agential force, ever pregnant with possible forms delivered by artist-midwives, (...) building Bloch’s messianic utopia. And Natural Law resurrects the Stoics’ concept of natural law as drawing on a prehistoric matriarchal utopia, later channeled by earth goddess cults misconstrued by the nineteenth-century German anthropologist Johann Jakob Bachofen as political matriarchy. I then conclude by linking this pregnant materialist natural law to Dionysus as son of the Great Mother Goddess. Though stigmatized throughout homophobic Western history for his queerness and maternal dependence, Dionysus is also the patron god of Bloch’s hero, the slave revolutionary Spartacus, paramour of a priestess of Dionysus who prophesied his divine mission of liberation. (shrink)

Pregnancy presents some interesting challenges for the philosophy of embodied cognition. Mother and fetus are generally considered to be passive during pregnancy, both individually and in their relation. In this paper, we use the enactive operational concepts of autonomy, agency, individuation, and participation to examine the relation between mother and fetus in utero. Based on biological, physiological, and phenomenological research, we explore the emergence of agentive capacities in embryo and fetus, as well as how maternal agency changes as pregnancy advances. (...) We show that qualitatively different kinds of agency have their beginnings already in utero, and to what extent fetal and maternal movement modulate affectivity and individuation in pregnancy. We thus propose that mother and fetus are both agents who participate in pregnancy. Pregnancy then emerges as a relational developmental organization that anchors and holds its developing participants. We end the paper with reflections on ethical implications of this proposal, and suggestions for future research. (shrink)

Although the positive outcomes achieved in home‐visiting interventions targeting young, disadvantaged mothers are partly credited to therapeutic relationships, researchers rarely offer philosophical or theoretical explanations for these relationships. This omission is a conspicuous oversight as nurse–family relationships have figured prominently in public health nursing practice since its inception. In this study, I suggest that the contribution of therapeutic relationships to positive outcomes will remain theoretically undeveloped as long as clinical trials and nursing practice models follow the logic of techne. After (...) describing how a scientific–clinical gaze misrepresents teen mothers and contributes to a rational–technical model of clinical practice, I draw on contemporary hermeneutics to describe how dialog and understanding are indispensable for clinical judgment and the judicious use of scientific knowledge. This hermeneutic corrective calls attention to the dialogical nature of truth and the relational skills that disclose meaning, preserve personhood, and support possibilities available in the life‐world. Dialogical understanding also disrupts the scientific–clinical gaze by disclosing the social disparities that are implicated in early childbearing and teen mothers’ long‐term prospects. The implications of this thought for legitimating and supporting the flexibility and clinical know‐how that ‘strays’ from protocol‐driven care is addressed. (shrink)

A decade of advocacy for the inclusion of pregnant women in the clinical research agenda is starting to pay off. In September, the United States Task Force on Research Specific to Pregnant Women and Lactating Women issued its advice to the secretary of Health and Human Services on addressing gaps in knowledge and research on safe and effective therapies for pregnant women and lactating women. The task force is pushing for major reforms. If its recommendations are taken (...) up, we can anticipate a significant shift in pregnancy research in the United States. This will affect pregnant women, clinicians caring for them, researchers, and institutional review boards. (shrink)

The turn from deterministic to probabilistic explanations has been used to argue that social science does not explain human action in ways that are incompatible with free will, since, according to some accounts of probabilism, causal factors merely influence actions without determining them. I argue that the notion of nondetermining causal influence is a multifaceted and problematic idea, which notably is unclear about whether the probability is objective or subjective, whether it applies to individual occurrences or merely to sets of (...) occurrences, and whether it is possible for an occurrence to be "almost determined.". (shrink)

The potential benefits of an alternative to physical gestation are numerous. These include providing reproductive options for prospective parents who are unable to establish or maintain a physiological pregnancy, and saving the lives of some infants born prematurely. Ectogenesis could also promote sexual equality in reproduction, and represents a necessary option for women experiencing an unwanted pregnancy who are morally opposed to abortion. Despite these broad, and in some cases unique benefits, one major ethical concern is the potential impact of (...) this emerging technology on abortion rights. This article will argue that ectogenesis poses a challenge to many common arguments in favour of a pregnant woman’s right to choose, but only insomuch as it highlights that their underlying justifications for abortion are based on flawed conceptions of what the foetus and pregnancy actually are. By interrogating the various interests and relationships involved in a pregnancy, this article will demonstrate that the emergence of artificial gestation need not impact existing abortion rights or legislation, nor definitions of independent viability or moral status. (shrink)

In this article the results of a study of psychological readiness of pregnant women to parenthood are presented. Psychological readiness is defined as a structure consisting of three components: the cognitive, emotional, and behavioral, which is consistent with the single theory of psychological processes L. M. Vekkera. It was found that the main component that determines the high level of psychological readiness for motherhood is a cognitive component. The content of the cognitive component includes an understanding of the child (...) as a value. Some results of the research of value orientations of pregnant women in the structure of psychological readiness for parenthood. To identify the value system of pregnant women, the method of ‘Value Orientations‘ by M. Rokich was applied. The analysis of empirical data was performed using factor analysis and U criterion of Mann-Whitney. Respondents were distributed into two age groups: first group of 21-25 years, second group of 26-30 years. All women are nulliparous. The younger age group of pregnant women is characterized by values that are directed at the outside world. Emotional component dominates in the structure of psychological readiness for motherhood. Values of women in the second group are aimed at children. Cognitive and behavioral components dominate in the structure of their psychological readiness for motherhood. Knowledge of the structure of psychological readiness of women to parenthood will help to diagnose disorders of maternal behavior, to design methods of its correction and prevention. (shrink)

This short story raises ethical issues about a woman’s request for medical assistance to get pregnant. In this fictional account, a 34-year-old woman has been trying to get pregnant for the last year. Her husband would like to keep trying for one more year, but the woman loses patience. She visits an ob-gyn and requests artificial insemination. She does not intend to tell her husband about this medical assistance. The doctor has helped single women, lesbian couples, and married (...) couples with pregnancies, but he feels conflicted by this request. The doctor and the woman discuss their concerns and plans. Then they decide on a course of action. In a creative way, this story aims to bring to life ethical issues about assisted reproduction, complex relationships, individual choice, non- judgmental attitudes, deception, confidentiality, genetic connections, and social parents. But this story is not a textbook case that illustrates a clearly defined ethical issue. On the contrary, the story shows that some common ethical ideas don’t quite fit the characters’ experiences and the readers’ reactions. (shrink)

How does pregnancy transform our embodiment? This question will be explored with the help of phenomenology and Butoh dance. Although Butoh has not yet been able to fulfil its true potential for disclosing female embodiment and particularly pregnant embodiment, it will provide us with helpful clues. In pregnancy, objects are less ready-to-hand, more out of reach - world as we know it becomes removed. The habit body vanishes away. But pregnancy is not just a loss of the ordinary: it (...) also opens up new dimensions. One such dimension is that of being touched from within. A phenomenology of the pregnant body thus leads to a removal of world, but also reveals new dimensions of world, and it even comes to disclose the other as a new world within. It means to carry something alien, like the stone in Butoh play Child’s Breath, which can only be carried slowly, awkwardly. (shrink)

The new federal Pregnant Workers Fairness Act advances important protections for pregnant workers, but leaves behind agricultural workers, who are overrepresented in hazardous occupational environments. This article highlights the connection between workplace pregnancy discrimination and health inequities. It concludes with a discussion of immigrant-led advocacy efforts to eliminate health inequities and advance health justice.

Abstract:This article analyzes the pervasive practice in US carceral institutions of shackling incarcerated pregnant women during childbirth and postpartum. After a review of bioethical, civil, and human rights norms, which widely condemn the practice, I advance an interpretation of the social meaning of shackling imprisoned pregnant women and its persistence despite widespread normative consensus in favor of its abolition. Two arguments regarding the persistence of the practice are considered: (1) that it stems from the unthinking exportation of prison (...) rules to a hospital setting and (2) that it is the product of an androcentric approach to punishment and carceral health care ill-adapted to women’s needs. I argue that these explanatory frameworks are inattentive to the intersecting genealogies of race and gender that are constitutive of the practice. As a result, the prescriptive horizons that these frameworks delineate are inadequate to the race- and gender-specific task of redress. Drawing from Black feminist theory and Nietzsche, I argue that the practice of shackling imprisoned pregnant women, like many ostensibly race-neutral facets of American mass incarceration, is a sedimentation of slavery that impacts all incarcerated women. The practice is symptomatic of the persistent anti-Blackness of the criminal legal system and the unfinished project of American abolition. (shrink)

Smajdor and Rasanen (2024) argue that pregnant women are routinely denied appropriate treatment because pregnancy is seen as normal, and so they are denied ‘patient status’. They claim that formally classifying pregnancy as a disease may lead to better treatment for pregnant women. In this response, we argue that pathologising pregnancy and classifying all pregnant women as ‘diseased patients’ won’t reconfigure care in ways that benefit all women. Rather, it will likely only embolden the view that clinicians (...) are entitled to exercise jurisdiction over pregnant women and beget the increased use of medical intervention where it is not necessarily needed. (shrink)

This article takes the rupturing of normative, linear, reproductive time that occurs in the event of miscarriage as a potentially generative philosophical moment—a catalyst to rethink pregnancy aside from the expectation of child-production. Pregnant time is usually imagined as a linear passage toward birth. Accordingly, the one who “miscarries” appears as suspended within an arrested journey that never arrived at its destination, or indeed, as ejected from pregnant time altogether. But here I propose to rethink both pregnancy and (...) miscarriage through the lens of “suspended time”—a theoretical move that shifts the accent from the future as the dominating frame of reference to the lived present. Drawing on work by Kathryn Bond Stockton, Lauren Berlant, Lisa Baraitser, and others, the article explores overlooked temporalities of pregnancy and miscarriage that operate not in the mode of futural projection or futural loss, but rather through present-oriented forms of adjustment and sensing, attachment and intimacy, maintenance and care. By “suspending the future,” then, we can resist the oppositional framing of pregnancy and miscarriage, because if pregnant time is not represented in exclusively future-oriented terms as being-toward-birth, then miscarriage need not be understood as pregnancy's undoing. (shrink)

In this article, we study health literacy as entangled and situated processes of authorisation of pregnant women to become competent caretakers of their own physical activity and health based on the development of the practice of ‘learning to take notice’. Based on our ethnographic fieldwork in a randomised controlled trial on physical activity during pregnancy called FitMum, we develop a processual conceptualisation of health authorisation as multidirectional flows between participants, staff and technologies. Using the concepts of attunement and authorisation (...) from Latour and Despret, we suggest that health literacy is not just something that can be acquired once and for all, but is processual and must be maintained, nurtured and developed through continuous negotiations, adjustments and adaptations to the constantly changing conditions of the health subject. (shrink)

In recent years, a number of news stories were reported worldwide involving brain-dead pregnant women. Debates over providing life support to braindead pregnant women and delivery of their children have been around for some decades. Maintaining a woman’s life solely for fetal viability has become a major controversial social issue. Opposing opinions exist where one side supports the woman and her child should be left to die in dignity and the other side claims to protect the unborn child’s (...) right to live. Each group has strong beliefs. This paper addresses main aspects when considering the continuation of somatic support to the brain-dead pregnant woman for the purpose of fetus delivery including; human death, dignity of the woman, rights of the fetus, proportionality of acts, and the woman’s donor status, and independence of mother and fetus. Then, the authors present several diverse opinions and positions concerning the legitimacy of life support for brain-dead women based on them and critically evaluate them. We show that each and every claim can be ethically refuted. This paper also approaches to those claims from three different points of views, which are that of the brain-dead woman, her fetus and her family. We believe that the brain-dead woman’s wish and dignity, the child’s predicted wellbeing after birth, and the family’s beliefs and welfare should all be counted equally when making the final decision. In conclusion, we argue that the decision can be ethically justified only when the interests of all parties are appropriately taken into consideration and protected. (shrink)

This paper explores how pregnancy discrimination at work is perceived by both employers and pregnant employees. Using a public, qualitative dataset collected by the UK Equality and Human Rights Commission that offers perspectives from both employers and pregnant employees, we explore the unfair and unethical treatment of pregnant employees at work. Our findings show how pregnant workers are expected to conform with workplace systems that are treated as sacred. We suggest that employer valorization of the mythical (...) figure of ‘ideal worker’ disadvantages pregnant workers. We observe how, even if this contravenes maternity protection laws, some employers self-justify discrimination against pregnant employees who they perceive to have transgressed ‘appropriate’ workplace behaviors as ethical and reasonable. To illuminate and conceptualize the notion of transgression, our analysis has led us to the ideas of philosopher Georges Bataille, specifically his reflections on how individuals who ‘transgress’ social norms are treated as taboo, as well as his metaphorical descriptions of people and practices as either sacred or profane. We theorize that pregnant workers who are treated as profane should be reclassified as sacred, opening up this idea for debate so as to disrupt long-standing patterns of discrimination. (shrink)

Pregnant women and their interests have been underrepresented in health research. Little is known about issues relevant to women considering research participation during pregnancy. We performed in-depth interviews with 22 women enrolled in either one of two trials sponsored by the National Institutes of Health to assess the safety and immunogenicity of the H1N1 vaccine during pregnancy. Three themes characterized women’s decisions to participate in research: they valued early access to the vaccine, they perceived a safety advantage when participating (...) in research, and they wanted to help advance scientific knowledge. However, there were also some considerations that would disincline them to participate in research—for instance, a significant risk of maternal or fetal harm, the presence of a placebo arm in a study, or a requirement to significantly change planned therapy or behavior. Pregnant women who participated in the H1N1 vaccine trials viewed research favorably, citing its advantages over standard clinical care. These findings emphasize that access to benefit should guide policy for including pregnant women in research. (shrink)

Courts and legislatures are increasingly being called upon to restrict the autonomy of pregnant women by requiring them to behave in ways that others determine are best for the fetuses they carry. The state should not attempt to transform pregnant women into ideal baby‐making machines. Pregnant women make decisions about their behavior in the context of the rest of their lives, with all the attendant complexities and pressures. Our interest in helping future children by improving prenatal care (...) would best be furthered by helping pregnant women to make informed, less constrained choices, not by punishing women or depriving them of choices altogether. (shrink)

This paper examines Hannah Arendt’s contribution to recent debate concerning the urgency of Martin Heidegger’s original ethics. To this end, I turn to Arendt’s existential interpretation of birth as this takes shape in her discourse on the miracle. Though recent commentators have criticized Arendt’s emphasis on the miracle, I argue that she deepens a conversation about birth that Dennis Schmidt, following Jacques Derrida, has set in motion in his efforts to contribute to a more original ethics. Whereas Schmidt prioritizes the (...) helplessness of the newborn, Arendt’s interpretation of the miracle suggests that birth reminds us not simply of our responsibility to help the helpless, but also of our responsibility to prepare the world for the incalculable possibilities of the newcomer. In this, I argue that Arendt brings into focus the ground of our responsibility to make space in the world for what cannot be reduced and decided on in advance by calculative procedure, thereby opening new paths to thinking the task of original ethics. (shrink)

Despite the attempts to promote the inclusion of pregnant women into clinical research, this group is still widely excluded. An analysis of the “vulnerability of pregnant women” that questions deeply internalized stereotypes is necessary for finding the right balance in the protection of pregnant women as research participants. Criticism of the traditional account of vulnerability will lead to an alternative that focuses on situations rather than groups and on the obligations of responsible parties. The paper adds to (...) the current general discussion of vulnerability and at the same time addresses the specific problem of drug treatment during pregnancy. (shrink)

In research involving pregnant women and fetuses, a number of questions arise concerning the balancing of risks and benefits. In research that holds out a prospect of direct benefit for the woman, how much risk to the fetus is permissible? How should the principle of minimizing risks be applied when there are two subjects—pregnant woman and fetus? Should risks for each of them be minimized? What if minimizing risks for one increases risks for the other? These and other (...) questions are not addressed in the current federal regulations for the protection of human subjects. This paper reviews the current regulations, attempts to identify issues that need to be addressed, considers alternative viewpoints concerning those issues, and argues for particular views. It concludes with a set of proposed guidelines for balancing risks and benefits in research involving pregnant women and fetuses. (shrink)

Recent global advances in available technology to prevent mother-to-child HIV transmission necessitate a rethinking of contemporary and previous ethical debates on HIV testing as a means to preventing vertical transmission. In this paper, we will provide an ethical analysis of HIV-testing strategies of pregnant women. First, we argue that provider-initiated opt-out HIV testing seems to be the most effective HIV test strategy. The flip-side of an opt-out strategy is that it may end up as involuntary testing in a clinical (...) setting. We analyse this ethical puzzle from a novel perspective, taking into account the moral importance of certain hypothetical preferences of the child, as well as the moral importance of certain actual preferences of the mother. Finally, we balance the conflicting concerns and try to arrive at an ethically sound solution to this dilemma. Our aim is to introduce a novel perspective from which to analyse testing strategies, and to explore the implications and possible benefits of our proposal. The conclusion from our analysis is that policies that recommend provider-initiated opt-out HIV testing of pregnant mothers, with a risk of becoming involuntary testing in a clinical setting, are acceptable. The rationale behind this is that the increased availability of very effective and inexpensive life-saving drugs makes the ethical problems raised by the possible intrusiveness of HIV testing less important than the child's hypothetical preferences to be born healthy. Health care providers, therefore, have a duty to offer both opt-out HIV testing and available PMTCT (preventing mother-to-child transmission) interventions. (shrink)

Background: Prenatal and postnatal mental disorders can exert severe adverse influences on mothers, fetuses, and children. However, the effect of the coronavirus disease 2019 pandemic on the mental health of pregnant and postpartum women remains unclear.Methods: Relevant studies that were published from January 1, 2019 to September 19, 2020 were identified through the systematic search of the PubMed, EMBASE, and Web of Science databases. Quality assessment of included studies, random-effects meta-analysis, sensitivity analysis, and planned subgroup analysis were performed.Results: A (...) total of 23 studies conducted with 20,569 participants during the COVID-19 pandemic and with 3,677 pregnant women before the COVID-19 pandemic were included. The prevalence rates of anxiety, depression, psychological distress, and insomnia among pregnant women during the COVID-19 pandemic were 37%, 31%, 70%, and 49%, respectively. The prevalence of postpartum depression was 22%. Multigravida women and women in the first and third trimesters of pregnancy were more vulnerable than other pregnant women. The assessment of the associations between the COVID-19 pandemic and mental health problems revealed that the pooled relative risks of anxiety and depression in pregnant women were 1.65 and 1.08, respectively.Conclusions: The prevalence rates of mental disorders among pregnant and postpartum women during the COVID-19 pandemic were high. Timely and tailored interventions should be applied to mitigate mental problems among this population of women, especially multigravida women and women in the first and third trimesters of pregnancy. (shrink)

There is increasing global pressure to ensure that pregnant women are responsibly and safely included in clinical research in order to improve the evidence base that underpins healthcare delivery during pregnancy. One supposed barrier to inclusion is the assumption that pregnant women will be reluctant to participate in research. There is however very little empirical research investigating the views of pregnant women. Their perspective on the benefits, burdens and risks of research is a crucial component to ensuring (...) effective recruitment. The Research In Pregnancy Ethics study set out to ascertain the views of pregnant women about research participation using an inductive thematic analysis. We conducted semi-structured interviews with 20 women who had participated in a double-blind randomised placebo controlled trial in Wellington while pregnant. Our results show that at least some pregnant women recognise the value and importance of research during pregnancy. The women we interviewed were deeply invested in the research process and outcomes. Key motivations for participating were altruism, playing a valuable civic role and the importance of research. The main perceived burdens related to inconvenience and time commitment. For some women, possible randomization to the placebo arm was regarded as a burden or disadvantage. (shrink)