A recent article on the front page of The Independent reported that the genetic ‘manipulation’ of IVF embryos is to start in Britain, using a new revolutionary gene-editing technique, called Crispr/Cas9. About three weeks later, on the front page of the same newspaper, it was reported that the National Health Service faces a one billion pound deficit only 3 months into the new year. The hidden connection between these reports is that gene editing could be used to solve issues related (...) to health care allocation. Improving the health of future generations might coincide with public health goals; it might improve the health of individuals and communities, and, if successful, might be seen as a public good. However, enhancing future generations will require In Vitro Fertilisation and Pre-implantation Genetic Diagnosis. Remarkably, the necessary involvement of women in an enhancing scenario has not been discussed by its proponents. The present discourse on moral obligations of future generations, although not referring to women, seems to imply that women might be required, morally, if not legally, to reproduce with IVF. Enhancing future generations will be gendered, unless the artificial womb is developed. These are challenging issues that require a wider perspective, of both women and men. Despite the lack of a unified feminist conclusion in the discussions about the merits and risks of human genome modification, there is an urgent need to clarify the role of women in this scenario. (shrink)

edited by Tuija Takala and Matti Häyry, welcomes contributions on the conceptual and theoretical dimensions of bioethics. The section is dedicated to the idea that words defined by bioethicists and others should not be allowed to imprison people's actual concerns, emotions, and thoughts. Papers that expose the many meanings of a concept, describe the different readings of a moral doctrine, or provide an alternative angle to seemingly self-evident issues are therefore particularly appreciated. The themes covered in the section so far (...) include dignity, naturalness, public interest, community, disability, autonomy, parity of reasoning, symbolic appeals, and toleration. All submitted papers are peer reviewed. To submit a paper or to discuss a suitable topic, contact Tuija Takala at [email protected]. (shrink)

In this paper, I argue that the development of an artificial womb is already well on its way. By putting together pieces of information arising from new scientific advances in different areas, (neo-natal care, gynecology, embryology, the human genome project and computer science), I delineate a distinctive picture, which clearly suggests that the artificial womb may become a reality sooner than we may think. Currently, there is a huge gap between the first stages of gestation (using in vitro fertilization) and (...) the 22nd week (inside the womb). At the present time this gap seems an insurmountable barrier for fully developing a fetus outside a natural womb – a notion better known as ectogenesis. The history of science however, suggests that impenetrable barriers are such only temporarily. It is just a matter of time (and due research) until someone – intentionally or by chance – accesses the right answer and finds a way to overcome existing obstacles. Despite misgivings that the case of the artificial womb presents too many barriers, it would be naïve to suppose things would happen any differently. I observe in this paper, that it is time to acknowledge the consequences of new developments in different areas of scientific research which are leading to the advent of an artificial womb; and I modestly suggest that we might initiate a discussion on this topic now, while we have still enough time to decide what we may want and why. (shrink)

The Israeli health care system is looked upon by some people as one of the most advanced health care systems in the world in terms of access, quality, costs and coverage. The Israel health care system has four key components: (1) universal coverage; (2) ‘cradle to grave’ coverage; (3) coverage of both basic services and catastrophic care; and (4) coverage of medications. Patients pay a (relatively) small copayment to see specialists and to purchase medication; and, primary care is free. However, (...) during 2011 the Israeli Medical Association (IMA) spent 5 months on a strike, justifying it as trying to ‘save’ the Israeli public health. This paper describes some aspects of the Israeli Health Care System, the criteria for setting priorities for the expenditures on health care and values underlying these criteria. The paper observes that the new agreement between the IMA and the government has given timely priority to problematic areas of specialization (in which there is an acute shortage of physicians) and to hospitals in the periphery of the country. Yet weak points in the health system in Israel remain. Particularly, the extent to which national health care expenditures are being financed privately—which is rising—and the parallel decline in the role of government financing. (shrink)

Background Past studies emphasized the possible cultural influence on attitudes regarding reprogenetics and reproductive risks among medical students who are taken to be “future physicians.” These studies were crafted in order to enhance the knowledge and expand the boundaries of cultural competence. Yet such studies were focused on MS from relatively marginalized cultures, namely either from non-Western developing countries or minority groups in developed countries. The current study sheds light on possible cultural influences of the dominant culture on medical students (...) in two developed countries, potentially with different dominant cultures regarding reprogenetics and reproductive risks: Israel and Croatia. Methods Quantitative-statistical analyses were employed, based on anonymous questionnaires completed by 150 first year medical students in Israel and Croatia. The questionnaires pertained to the knowledge and attitudes regarding genetics, reproduction and reproductive risks. These questionnaires were completed before the students were engaged in learning about these topics as part of the curriculum in their medical school. Results Substantial differences were revealed between the two groups of medical students. Israeli medical students were less tolerant regarding reproductive risks and more knowledgeable about genetics and reproductive risks than Croatian medical students. For example, while nearly all Israeli medical students disagreed with the idea that “Screening for reproductive risks in prospective parents is wrong,” less than 40% of their Croatian counterparts shared a similar stance. Similarly, all Israeli medical students correctly observed that “A carrier of a recessive genetic disease actually has the disease” was wrong, as opposed to only 82% of Croatian students. Conclusions By linking applicable theoretical literature to these findings, we suggest that they may reflect the hidden influence of the dominant culture in each country, disguised as part of the “culture of medicine.” Acknowledging and learning about such influence of the dominant culture, may be an important addition to the training of medical students in cultural competence, and specifically their cultural awareness. Such an acknowledgement may also pave the road to drawing the attention of existing physicians regarding a less known yet an important aspect of their cultural competence, insofar as the cultural awareness component is concerned. (shrink)

In a recent article Matty Häyry observes that human reproduction is both irrational and immoral1; hence, he suggests, those who seek help before conceiving, “could be advised it is all right not to have children”. Häyry believes that if prospective parents are told that “according to at least one philosopher it would be all right not to reproduce at all” this could empower people “to make the rational choice to remain childless”; valiantly, he suggests himself as “the one philosopher to (...) be blamed for this unpopular idea”.In a rejoinder to Matty Häyry, Søren Holm claims it is not strongly irrational to have children2; S Aksoy contends that having children is the biggest dream of many married couples, and “the major goal in a couple’s life”3; Rebecca Bennet, accepts that human reproduction may be irrational but in most cases she thinks this is morally defensible.4Matty Häyry does not need my help to defend himself; I will …. (shrink)

While some people claim that the present disagreement over embryonic stem cell research cannot be resolved, others argue that developing transparency and trust are key elements that could resolve the existing disagreements over such research. This paper reveals that transparency is not necessarily a requirement for advancing ES cell research, since in Israel, for instance, there is no transparency, and research nevertheless flourishes. Moreover, trust is not independent of cultural values and religious beliefs. Because of these beliefs, the environment in (...) Israel for ES cell research has been pragmatic and liberal. The Israeli case illustrates the key role that culture and religion can play in biomedical research; it also suggests that as far as cultural values or religious beliefs of people in Western countries strongly oppose research on embryonic tissue, it would be very difficult, if not impossible, to overcome the disagreements. (shrink)

During the last congress of the International Association of Bioethics in Beijing, there was a special session on human enhancement. John Harris, pioneer in the discussions on the ethics of enhancement,1 summarised this session, describing the focus of different panelists.2 This session included: Biopsychological enhancements The possibility of regulating emotions through pharmacological means Biases that may affect our judgments against human enhancement Health care inequalities that will follow from the adoption of genetic technology Social impact and costs of adopting the (...) new technology A discussion on women enhancing their physical strength as men through genetic modification .The Beijing panel did not address women’s involvement in the enhancement scenario. Of course, not every aspect of a topic can be covered in one session of a congress and some aspects may remain unaddressed; mainly, because these sessions draw from the research interests of the presenters. However, neither John Harris nor Julian Savulescu has yet addressed women’s crucial involvement in the enhancement scenario. It is the aim of this paper to draw attention to the invisibility of the ‘vessel’ in these discussions. Enhancement may be justified; but clearly, it will also affect women. In this scenario, will women be worse off?LATE ONSET DISEASES AND ENHANCEMENTFirstly, I would like to point out that I believe that enhancement may be a necessary step in the future of human evolution. As I have explained elsewhere,3 health care systems in the developed world are near to collapse under the pressure of late onset chronic diseases. Largely successful in preventing early deaths in the last century, health care systems have prompted a new plague, recognised lately by the World Health Organization as a new pandemic …. (shrink)

Policies on reproduction have become an increasingly important tool for governments seeking to meet the so-called demographic ‘challenge’ created by the combination of low fertility and lengthening life expectancies. However, the tension between the state and the market in health care is present in all countries around the world due to the scare resources available and the understandable importance of the health issues. The field of assisted reproduction, as part of the health care system, is affected by this tension with (...) both—the state’s and the market’s involvements—carrying important implications. Bulgaria and Israel share the same size of population, are markedly paternalistic and both have strong pro-natalist cultures by which large families are expected. For a range of reasons the two countries contrast sharply, however, in terms of their capacity to intervene in the health system, and also in terms of the political will to act on matters of reproduction. This paper examines how assisted reproduction, as reflected by present policies in both countries, influences women’s welfare and considers whose interests the practices of assisted reproduction in these countries actually serve. By reviewing some of the present data on women’s status in Bulgaria and Israel and assessing both states’ policies and involvement in assisted reproduction this paper helps to identify some of the intended and unintended consequences of assisted reproduction policies in different countries. (shrink)