Volume 20, Issue 3, March 2020, Page 88-90.

In a recent article in the American Journal of Obstetrics and Gynecology, Frank Chervenak et al. argue that home birth is less safe than hospital birth, and that physicians have a dual duty to avoid any collaboration with home birth midwives and to make hospital birth more psychologically and socially supportive to accommodate women who want more choices during labor. The assertion that home birth is significantly less safe than hospital birth has been responded to by Howard Minkoff and Jeffrey (...) Ecker and by a recent large observational study of home birth outcomes in America. Minkoff and Ecker argue that the evidence supports, at most, a minimal increased.. (shrink)

Daniel Callahan, in his short article “Hans Jonas and Death,” writes that while he appreciates the perspective on death offered by Jonas in his “The Burden and Blessing of Mortality,” he is concerned by certain omissions that suggest Jonas may not have fully appreciated the value of life. Callahan writes that Jonas does not say “a great deal about why life is worth living,” give an account of the “meaning of evolution for human life,” or describe the “experiences and possibilities (...) in the content of the lives of the human species not found in any other one”. I argue that Jonas not only explicitly addresses the meaning of evolution for human life but also develops an ethics rooted in the inherent value of all present and future life, with particular emphasis on the value of human life. (shrink)

The clinical relevance of whole-exome sequencing is unquestionable. In the prenatal setting, the standard testing process of reflexing from karyotype to microarray to single-gene disorders may take several weeks, leaving a family in prolonged turmoil and often without answers in time to make a decision about the pregnancy. WES provides a powerful amount of data more quickly and with a higher yield of diagnostic results, allowing a timelier plan for medical management and decision-making. However, while results that pertain specifically to (...) the testing indication can be isolated, the potential for incidental findings or results that are unrelated to the original testing indication is significant. In 2013, ACMG published recommendations for reporting incidental or secondary findings, providing a list of 57 clinically actionable genes for which reporting should be obligatory. These recommendations were updated in 2015 to include the option to opt out of receiving all secondary findings. The list includes childhood-onset conditions, for which medical management would be immediately impacted. However, the list also includes adult-onset conditions such as hereditary breast and ovarian cancer and Lynch syndrome. Historically, decisions regarding genetic testing for these conditions have been left up to the individual until they reach the age of consent. While the 2015 recommendations are an improvement over the 2013 recommendations insofar as they allow an option to opt out of receiving secondary findings, the recommendations continue to have potentially troubling ethical consequences. (shrink)