The Obama administration’s HHS mandate to force Catholic and other religious organizations to provide insurance coverage for morally objectionable practices has been the source of a great deal of controversy. While the religious liberty question has received the most attention, the mandate reveals a yet deeper problem in the mainstream acceptance of contraception and even abortion as a normal part of medical practice. The author argues that these practices constitute a deep corruption of medicine itself, away from (...) its original meaning as a kind of restorative justice grounded in a substantive understanding of the human good and towards a formalist emphasis on preference satisfaction and patient autonomy. (shrink)

The debate concerning the so-called U.S. Health and Human Services Contraception Mandate has been adequately framed, in the academic field, within the traditional ethical doctrine on cooperation with evil. This principle will allow us to conclude whether employers may ethically comply with the onerous existing law or not. The discussion has been quite heated, because the practical conclusions authors have reached vary widely, depending on which interpretation of the theory they rely on. In this paper, some of these (...) explanations are addressed and analyzed from the standpoint of the Thomistic theory of action, which is now the most common point of view. This work concludes that, although the Contraception Mandate will most likely be repealed by the current U.S. administration, as things once stood, compliance with it may have been ethically licit in some cases. (shrink)

The Catholic Church proscribes methods of birth control other than sexual abstinence. Although the U.S. Food and Drug Administration (FDA) recognizes abstinence as an acceptable method of birth control in research studies, some pharmaceutical companies mandate the use of artificial contraceptive techniques to avoid pregnancy as a condition for participation in their studies. These requirements are unacceptable at Catholic health care institutions, leading to conflicts among institutional review boards, clinical investigators, and sponsors. Subjects may feel coerced by such mandates (...) to adopt contraceptive techniques inconsistent with their personal situation and beliefs; women committed to celibacy or who engage exclusively in non-heterosexual activities are negatively impacted. We propose principles to insure informed consent to safeguard the rights of research subjects at Catholic institutions while mitigating this ethical conflict. At the same time, our proposal respects the interests of pharmaceutical research agencies and Catholic moral precepts, and fully abides by regulatory guidance. (shrink)

The 2012 contraception mandate issued by the US Department of Health and Human Services has intensified the debate over a health care practitioner’s right to conscientiously object to providing contraception. This paper approaches the debate over conscientious objection to contraception from a pharmacist’s standpoint. It shows that contraception is the cause of or a contributing factor to observed psychosocial suffering and is not “preventive health care” as labeled. It argues not only that a pharmacist should (...) have the right to conscientiously object to dispensing contraception but also that, given the mission of the pharmacist as a health care practitioner, a pharmacist is obligated to refuse to dispense contraception. The paper argues that the obligation to refuse to dispense contraception applies to all who are involved in the provision of health care. National Catholic Bioethics Quarterly 12.4 (Winter 2012): 675–696. (shrink)

In this paper, I analyze Simone de Beauvoir’s goals for women expressed in The Second Sex and compare these goals to the opportunities created by the Affordable Care Act’s contraceptive mandate. Though the contraceptive mandate advances Beauvoir’s goal of concrete equality by supporting economic independence and recognizing women’s sexual freedom, there are social and political limitations to these advancements.

State laws dictating “informed consent” about surgical and chemical abortions sometimes ensnare emergency contraceptives, as the science surrounding EC shows. Courts evaluating mandated disclosures gravitate to professional norms rather than the information most women would value: basic factual information about EC so that they can decide for themselves whether to use these drugs.

In 2014, the American Academy of Pediatrics published its policy statement on contraception for adolescents, which provides, in effect, a mandate to temporarily sterilize all adolescents with long-acting reversible contraceptives for five to ten years. The author reviews the AAP guidelines and their effects on Catholic adolescents, their families, and adolescent health care providers. He then discusses medicolegal issues raised by the policy, outlines Catholic strategies for combating it, and proposes a diocese-based physician-led program for teaching and counseling (...) elementary and high school students. (shrink)

The institutional review board at the University of Nebraska Medical Center has a policy on contraceptive use in research that aims to balance the protection of potential fetuses from potential harm resulting from drug exposure in research against respect for the autonomy of women research participants. The policy draws on the U.S. Food and Drug Administration’s Use-in-Pregnancy categories in an innovative way. These categories are meant to help prevent the exposure of fetuses to harmful drugs when used for therapy by (...) pregnant women. The UNMC IRB policy applies the FDA categories as a guideline for mandating contraceptive use among research participants. Clinical trials of drugs in the different FDA categories require different levels of contraceptive protection under the UNMC IRB policy. Though we agree with the insight that contraceptive requirements in research could helpfully be guided by the current and future FDA Use-in-Pregnancy guidelines, we argue that in several places, the UNMC IRB policy unjustifiably prioritizes the protection of potential fetuses from potential harm at the expense of respecting the autonomy and well-being of women research participants. In response to the deficiencies we identify in the UNMC IRB policy, we formulate an alternative, ideal policy on contraceptive use in research. (shrink)

In March 2010, President Obama signed into law The Patient Protection and Affordable Care Act (ACA). Although there is much in the ACA that is endorsed by the Catholic health ministry, the many positive provisions of the ACA have been overshadowed for the Catholic Church and the Catholic healthcare community by the controversial provisions requiring access to all FDA-approved sterilization and contraceptive medications (75 Fed. Reg. 137 (19 July 2010)) Typically, these drugs and services have not been covered by the (...) health plans of many religious employers including Catholic hospitals, universities, and social service agencies. Acknowledging the existence of religious-based objections to the provisions of these .. (shrink)

The essay begins with an explanation of St. Alphonsus Liguori’s understanding of the distinction between formal and material cooperation, identifying also some problems inherent in that understanding. The essay goes on to expound related ideas in the writings of St. Thomas Aquinas, ideas that are applicable to cases not easily analyzable by means of the distinction between formal and material cooperation. The essay then applies these ideas to two contemporary issues: the use of vaccines connected in some way with abortions (...) and the objection by the Little Sisters of the Poor to the contraceptive mandate issued by the US Department of Health and Human Services. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:A Culture of Engagement: Law, Religion, and Morality by Cathleen KavenyAllen CalhounA Culture of Engagement: Law, Religion, and Morality Cathleen Kaveny WASHINGTON, DC: GEORGETOWN UNIVERSITY PRESS, 2016. 320 pp. $98.95 / $32.95It is encouraging to read a book on the intersection of religion and law from an author as conversant with both fields as is Cathleen Kaveny. Reworking a number of columns that she wrote for Commonweal magazine, (...) Kaveny offers her concept of a "culture of engagement" as an alternative to America's polarizing culture wars. She builds a vision of engagement—typified by Pope Francis's emphasis on the church's need to "encounter" all human beings—that welcomes the influence that religious traditions and the broader culture and its laws can have on each other.Kaveny notes two ways in which the Roman Catholic tradition is particularly well situated to engage American culture and law. First, both American common law and the Catholic moral tradition use forms of "casuistry" to connect general rules with particular situations. Second, Catholic reluctance "to draw sharp lines between the pure and the tainted" can supply a salutary alternative to the Puritan tendency toward "prophetic indictment" (16).In part 1, Kaveny argues that law has both pedagogical and pragmatic qualities. In part 2, she describes the nation's struggle to balance governmental interests and religious liberty in the context of the contraception mandate in the 2010 Affordable Care Act. She faults the United States Conference of Catholic Bishops for elevating the law's pedagogical role over its pragmatic function in their attack on the mandate. She herself leans toward pragmatism; she assumes that exceptions to laws of general applicability should apply only "in the most extreme cases" (116) and that the government—not the religious claimant—should determine when exceptions apply.Kaveny also suggests that the bishops would do well to pay greater attention to the common good, as "it reflects the moral consensus of the community, which is accurately reflected in our democratic process of lawmaking" (90). Development of the grounds for this optimistic linking of a moral consensus and majority rule to the common good would have been an interesting addition to the book.Part 3 is the heart of the work, exploring ways for American society to "move beyond a culture war mentality" (120). Kaveny resists the assumption that public discourse in a society torn by culture wars is served by pitting secular and religious voices against each other. She hopes instead for persuasion based on natural law. One is left wondering, however, how persuasion based on natural law could happen in America's ideologically diverse culture. [End Page 201]Part 4 explores the effect of America's ideological pluralism on discussions among American Catholics. Kaveny describes how the church's sexual abuse scandal has fed the growing sense of disconnection between church teaching and the expectations of the Catholic laity.Part 5, a series of essays on difficult ethical controversies, hints at what interaction between the American and Catholic traditions might look like. Kaveny advocates "reframing the question" and hints at what reframing the contraception question might look like (221).Some of the book addresses specifically Catholic questions. It is valuable in that respect. Its scope extends beyond any one religious tradition, however, as it offers a picture of engagement between equals: the American legal tradition and Catholic moral teaching. Nevertheless, Kaveny makes it clear that this sort of engagement can succeed only if the American legal community understands its need to reflect changing social values and the Catholic hierarchy moves away from insisting that "error has no rights" and toward acknowledging that people do have rights even when they are in error (257).Allen CalhounPhD candidate, University of AberdeenCopyright © 2018 Society of Christian Ethics... (shrink)

Judaism, like Gilbert Meilaender, analogizes food and sex. Traditionally, Judaism saw the primary purpose of sex as procreation, the fulfillment of a biblical mandate. It did not, however, link sex to the Garden of Eden story, and it acknowledged that sex was also important for couples' bonding. While Meilaender sees bonding as a value co-equal with procreation, Judaism traditionally kept procreation as the primary goal. Couples were encouraged to have sex when infertile and were permitted contraception when pregnancy (...) endangered life, but whenever possible, they were directed to also have sex for procreation. Many modern rabbis, in agreement with Meilaender, permit contraception in order to foster bonding as a separate goal of sex. However, reproductive technology is seen, in Judaism, as partnership with God, allowing for a process of birth that is as natural as the process of producing food by farming. Last, when sex is permitted, Judaism celebrates the joy attendant to sex as a Divine gift. (shrink)

On January 25, 2013, theFederal Registerpublished the Department of Health and Human Services omnibus amendments to the Health Insurance Portability and Accountability Act Privacy, Security, Enforcement, and Breach Notification Rules. These modifications also include the final versions of the HIPAA regulation amendments mandated by the Health Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act. Although the amended rules were effective on March 26, 2013, covered entities and their business associates have a compliance date of (...) September 23, 2013.It has been 10 years since the April 14, 2003 compliance date for the original HIPAA Privacy Rule. Despite HHS’ clarification of some issues by posting answers to frequently asked questions, there have been no significant amendments to the Privacy Rule since 2003. (shrink)

This issue’s “Legal Briefing” column covers legal developments pertaining to conscience clauses and conscientious refusal. Not only has this topic been the subject of recent articles in this journal, but it has also been the subject of numerous public and professional discussions. Over the past several months, conscientious refusal disputes have had an unusually high profile not only in courthouses, but also in legislative and regulatory halls across the United States.Healthcare providers’ own moral beliefs have been obstructing and are expected (...) to increasingly obstruct patients’ access to medical services. For example, some providers, on ethical or moral grounds, have denied: (1) sterilization procedures to pregnant patients, (2) pain medications in end-of-life situations, and (3) information about emergency contraception to rape victims. On the other hand, many healthcare providers have been forced to provide medical treatment that is inconsistent with their moral beliefs.There are two fundamental types of conscientious objection laws. First, there are laws that permit healthcare workers to refuse providing — on ethical, moral, or religious grounds — healthcare services that they might otherwise have a legal or employer-mandated obligation to provide. Second, there are laws directed at forcing healthcare workers to provide services to which they might have ethical, moral, or religious objections. Both types of laws are rarely comprehensive, but instead target: (1) certain types of healthcare providers, (2) specific categories of healthcare services, (3) specific patient circumstances, and (4) certain conditions under which a right or obligation is triggered. For the sake of clarity, I have grouped recent legal developments concerning conscientious refusal into eight categories: 1. Abortion: right to refuse2. Abortion: duty to provide3. Contraception: right to refuse4. Contraception: duty to provide5. Sterilization: right to refuse6. Fertility, HIV, vaccines, counseling7. End-of-life measures: right to refuse8. Comprehensive laws: right to refuse. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Protecting Human Research SubjectsThe Office for Protection from Research RisksJoan Paine Porter (bio)The office for Protection from Research Risks (OPRR), located within the National Institutes of Health, has two divisions: Human Subject Protections and Animal Welfare. This article will address the overall responsibilities and current projects relating to human subject protections.OPRR implements the Department of Health and Human Services' (HHS) regulations for the protection of human subjects (45 CFR (...) 46 (1991)). These regulations fulfill the responsibilities set forth in the Public Health Service (PHS) Act with regard to institutional review boards (IRB) and other protections for human subjects involved in biomedical and behavioral research conducted or supported by HHS. The PHS Act also mandates a program to clarify ethical issues in biomedical research involving human subjects and to address violations of the rights of human subjects of research (P.L. 99-158 (1985)).OPRR staff negotiate assurances of compliance with institutions conducting Federally-supported research involving human subjects. The assurances describe the policies and procedures each institution will follow to fulfill the requirements of the regulations, including specific IRB composition and functions.In addition, OPRR cosponsors with the Food and Drug Administration and awardee institutions a series of regional workshops that address human subject protections issues. These are attended by IRB members, institutional officials, research investigators, and others involved with human subject protections.Current ActivitiesNumerous activities are underway in OPRR. The following describes only a few of the initiatives and studies aimed at helping develop policies and procedures to protect human subjects of research."Points to Consider" DocumentsOPRR is currently working with the National Center for Human Genome Research (NCHGR) to develop a "points to consider" document for IRBs and others involved in large genetic pedigree studies. Many questions have emerged [End Page 279] on topics such as how subjects should be recruited, with whom information should be shared about others in the family, social risks of disclosure in employment and insurance, the circumstances and timing of informing subjects about study results, and involvement of children. OPRR and NCHGR hope to assemble a group this fall to review and refine the points that are now being developed jointly. A conference in South Carolina organized by the American Association for Advancement in the Sciences entitled "Project on the Ethical and Legal Implications of Genetic Testing," helped generate advice, and identified some of the more controversial issues in design and conduct of genetic research that involves large groups of family members.Another "points to consider" effort concerns enrollment of women and minorities in research. The PHS has established a policy that members of these groups must be included in research projects unless there are valid scientific justifications for their exclusion which can be made on a project by project basis (ADAMHA/NIH Policy 1990; NIH/ADAMHA Policy 1990). OPRR has commissioned several scholarly papers to help in developing "points to consider" for IRBs as they balance issues of equitable selection of subjects and protection of these selected individuals. Concerns about enrolling women of childbearing age in research that may be harmful to a fetus, and liability issues frequently dominate discussion in this area. The papers will address ethical, legal, and statistical aspects of enrollment of minorities and women as well as provide a description of various practices and roles of IRBs in addressing goals of fair selection of participants and appropriate protections.OPRR is also working with the PHS Panel on Women, Adolescents and Children to produce a document, also in the form of "points to consider" guidance, concerning enrollment of children who are wards of the state in HIV-related research. Subpart D of the regulations for the protection of human subjects (45 CFR 46) specifically addresses research involving children who are wards of the state, including the special protections that must be provided. State and local officials who have authority to enroll foster care children in research have indicated a desire to obtain advice in this area.The IRB GuidebookA major project that is now being completed under contract to the Poynter Center at Indiana University is the IRB Guidebook. It will revise and expand the current IRB Guidebook produced in the 1980s... (shrink)

This paper sketches a framework for the separation of church and state and, with the framework in view, indicates why a government’s maintaining such separation poses challenges for balancing two major democratic ideals: preserving equality before the law and protecting liberty, including religious liberty. The challenge is particularly complex where healthcare is either provided or regulated by government. The contemporary problem in question here is the contraception coverage requirement in the Obama Administration’s healthcare mandate. Many institutions have mounted (...) legal challenges to the mandate on grounds of religious freedom. The paper proposes a number of interconnected principles toward a resolution of the problem: for the institutional realm, specific principles for church-state separation and a principle concerning the protection of citizens’sense of identity; and for the ethics of citizenship in the conduct individuals, principles that provide an adequate place for natural (thus secular) reason in lawmaking and political decisions. (shrink)

In U.S. v. American Library Association (2003), the Supreme Court upheld the Child Internet Protection Act (CIPA), which mandated that libraries receiving federal funding for public Internet access install content-filtering programs on computers which provide that access. These programs analyze incoming content, and block the receipt of objectionable material, in particular pornography. Thus, patrons at public libraries are protected from unintentionally (or intentionally) accessing objectionable material, and, in the case of minors, from accessing potentially damaging material. At least, that is (...) the official story. In this paper, I develop three points. (1) I argue that CIPA and ALA are better read as examples of the enforcement of a regime of normative sexuality. The question of minors accessing pornography is only relevant to the official story insofar as it provides a rhetorically persuasive example of deviance from that normative regime. CIPAs full target includes information about topics such as homosexuality and contraception. (2) Rather than (or in addition to) punishing deviances directly, CIPA attempts to constitute a “public” in which such deviancy can never occur in the first place. Hence, the designation of a “public” space serves to domesticate alternative sexualities and to sanitize that space of sexual difference. (3) This interaction at the border of the public and private spheres offers an opportunity to reflect on and underscore the ways that subject formation and subjectivity are mediated through technological artifacts like the Internet. (shrink)

The recent confirmation of the constitutionality of the Obama administration’s Patient Protection and Affordable Care Act (PPACA) by the US Supreme Court has brought to the fore long-standing debates over individual liberty and religious freedom. Advocates of personal liberty are often critical, particularly in the USA, of public health measures which they deem to be overly restrictive of personal choice. In addition to the alleged restrictions of individual freedom of choice when it comes to the question of whether or not (...) to purchase health insurance, opponents to the PPACA also argue that certain requirements of the Act violate the right to freedom of conscience by mandating support for services deemed immoral by religious groups. These issues continue the long running debate surrounding the demands of religious groups for special consideration in the realm of health care provision. In this paper I examine the requirements of the PPACA, and the impacts that religious, and other ideological, exemptions can have on public health, and argue that the exemptions provided for by the PPACA do not in fact impose unreasonable restrictions on religious freedom, but rather concede too much and in so doing endanger public health and some important individual liberties. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:preface This issue of Feminist Studies explores the ways institutions—legal, governmental, medical, educational, and household—participate in the gendering of bodies and are themselves gendered. At any given historical moment, dominant and resistant meanings of “women,” “gender,” and “sexuality” are socially and politically constituted in institutions through cultural struggles. The authors in this issue discuss how birth control, assisted reproduction, transsexual transition, hegemonic masculinity, abortion, and domestic violence are each (...) articulated and contested in imperial law and economic discourses (Sreenivas), in medical procedures (Whitehead et al. and DasGupta), in university research regulations (Barnes and Munsch), and in the official practices of presidents (Mattingly ). Our authors elucidate how such institutions are gendered, not just in terms of staffing by males, females, and nongender conforming people, but also in the ways they constitute gender relations in their everyday operations. The articles point to the continuing need for institutional histories and ethnographies that are feminist in conception and design. They also provide openings into more progressive gender and sexuality politics by underscoring the contradictions within all institutions. Mytheli Sreenivas’s “Birth Control in the Shadow of Empire: The Trials of Annie Besant, 1877–1878” visits the contradictory history of institutions of reproduction control. She traces Besant’s contraception advocacy in the 1870s, reminding us of its intimate and unsavory entanglements with the politics of empire. Annie Besant is a complicated figure. South Asianists familiar with her later campaign against British colonialism in India might well be surprised by this earlier incarnation, but Sreenivas demonstrates how and why the early Besant held contradictory positions. As an individual, Besant questioned gender norms and challenged the inequality of women in marriage and divorce. She recognized sexual desire as “natural” (albeit only properly expressed via heterosexual marriage). Yet a signature feature of her political writing 504Preface was an embrace of neo-Malthusianism. Over the course of her activist life, Besant redirected her attention from poverty and women’s health in Britain to contraception as the solution to starvation and overpopulation in India. She did so in “a broader context in which a defense of empire and class-race hierarchy enjoyed far greater legitimacy than a critique of gender and sexual norms.” The repercussions of her actions were global: “Besant’s efforts rendered contraception into a sexual technology that claimed to address the economies of impoverishment in an emerging imperial world. Birth control thus emerged as both an imperial responsibility and as a demonstration of British humanitarianism in support of starving colonized populations.” Sreenivas explicates what the Besant trials reveal about the multiple histories of reproduction control and the conditions under which birth control continues to be both a technology for large-scale population control and “a vehicle for women’s reproductive freedom and gender justice.” Institutions are saturated with power, but they are also arenas where political struggles between different social groups are staged. This is especially evident in White House politics in the United States. In the late 1970s, President Jimmy Carter appointed a large number of women to bureaucratic offices. Many were feminists. Why did they fail to deliver gender justice? This is the puzzle Doreen J. Mattingly seeks to answer in “The Limited Power of Female Appointments: Abortion and Domestic Violence Policy in the Carter Administration.” The article is set in the broader context of a moment in history when the US feminist movement was moving from the streets to state bureaucracies, when women of color had broadened the movement’s mandate, and when the need for government programs to support poor women was a clearly articulated feminist goal. There was an excitement about transforming gender relations as feminists populated multiple organizations and came together to collaborate. However, two important legislative efforts—government funding for abortions for poor women and a national anti-domestic violence bill—failed. Mattingly traces the back and forth between Carter and his Assistant Secretary for Public Liaison, Margaret “Midge” Costanza, drawing on new archival sources. Mattingly’s article underscores how women in public office can be discursively valorized as symbols of change even while politically powerful men oppose meaningful policy that would provide women greater autonomy over their reproductive or violently transgressed bodies. Mattingly’s careful reconstruction... (shrink)

Stephen M. Krason presented this talk at the “Stand Up for Religious Freedom” rally in Buffalo, New York on June 8, 2012. It was one of many that were held around the U.S. that day, to show opposition to the attempt by the Obama administration’s Department of Health and Human Services to mandate that religious entities provide free contraceptives and sterilization procedures in their health insurance programs.

Due to a history of coerced sterilization, a federal Medicaid sterilization policy mandates that a specific consent form be signed by a patient at least thirty days prior to when the patient undergoes sterilization. However, in contemporary obstetrical practice, the Medicaid sterilization policy serves as a policy‐level barrier to autonomously desired care. We review the clinical and ethical implications of the current Medicaid sterilization policy. After discussing the utility and impact of waiting periods for other surgical procedures, we explore the (...) psychology of time required for decision‐making and consider scientific understanding of regret. We argue that the current Medicaid sterilization waiting period is clinically and ethically unjustifiable and that the policy ought to be revised in light of the goals, preferences, and concerns of the people most affected by it. While the need for continued protection against coercion remains, the current mandated waiting period does little to enforce the high‐quality shared decision‐making that is desired for sterilization counseling. (shrink)

OBJECTIVE: How outside factors affect physician decision making remains an open question of vital importance. We sought to investigate the importance of various influences on physician decision making when clinical guidelines differ from patient preference. -/- METHODS: An online survey asking 469 primary care providers (PCPs) across four practice sites whether they would order magnetic resonance imaging for a patient with uncomplicated back pain. Participants were randomized to one of four scenarios: a patient's preference for imaging (control), a patient's preference (...) plus a colleague's opinion against imaging (colleague), a patient's preference plus a professional society's recommendation against imaging (profession), or a patient's preference plus an accountable care organization's quality metric that measures physician use of imaging (ACO). Demographic information and the reasoning behind participants' decisions also were obtained. -/- RESULTS: A total of 168 PCPs completed the survey, yielding a 36% completion rate. A majority chose not to pursue imaging: control 68%, colleague 85%, profession 87%, and ACO 78%. Multivariate logistic regression revealed that participants were more likely not to order advanced imaging only when reminded of a professional society recommendation (P = 0.017). Regression also suggested that practice site exerted an effect on the primary outcome. Evidence-based medicine and clinical judgment were the most cited reasons for the decision. -/- CONCLUSIONS: Our results reinforce the potential to leverage professional societies to advance evidence-based medicine and reduce unnecessary testing. At the same time, practice site appeared to exert influence, suggesting that these recommendations must be part of local institutional culture to be effective. (shrink)

Soluble components of Notch signalling can be applied to manipulate a central pathway essential for the development of metazoans and often deregulated in illnesses such as stroke, cancer or cardiovascular diseases. Commonly, the Notch cascade is inhibited by small compound inhibitors, which either block the proteolysis of Notch receptors by γ‐secretases or interfere with the transcriptional activity of the Notch intracellular domain. Specific antibodies can also be used to inhibit ligand‐induced activation of Notch receptors. Alternatively, naturally occurring endogenous inhibitors of (...) Notch signalling might offer a specific way to block receptor activation. Examples are the soluble variants of the canonical Notch ligand Jagged1 and the non‐canonical Notch ligand Dlk1, both deprived of their transmembrane regions upon ectodomain shedding, or the bona fide secreted molecule EGFL7. We present frequently used methods to decrease Notch signalling, and we discuss how soluble Notch inhibitors may be used to treat diseases. (shrink)

Pharmacists with religious or ethical objections to prescribing emergency contraception won the latest round in the fight over conscience clauses in a case that could have broader implications for attempts to restrict access to contraception. In Stormans, Inc. v. Selecky, a federal District Court in Washington State granted an injunction to block the enforcement of regulations that would have forbidden pharmacists to refuse to dispense emergency contraception on the grounds of religious or ethical objections. In its decision, (...) the court applied Supreme Court abortion precedent without explicitly ruling whether emergency contraception should be legally categorized as a form of abortion or as contraception. However, the legal status of emergency contraception affects the strength of the defendants’ claims that the law was justified on the grounds of preventing sex discrimination. In neglecting to rule one way or the other, the court not only failed to adequately consider the sex discrimination claim but also may have opened the door to more restrictive regulation on contraceptives generally. (shrink)

Don Marquis’ future-like-ours account argues that abortion is seriously immoral because itdeprives the embryo or fetus of a valuable future much like our own. Marquis was mindful ofcontraception being reductio ad absurdum of his reasoning, and argued that prior tofertilisation, there is not an identifiable subject of harm. Contra Marquis, Tomer Chaffercontends that the ovum is a plausible subject of harm, and therefore contraception deprives theovum of a future-like-ours. In response, I argue that being an identifiable subject of harm (...) is notsufficient for Marquis’ argument to succeed. In addition, we must also share our identity withan ovum. I show that on the account of personal identity utilised by Marquis’ defenders, weare not identical with an ovum. As a result, Chaffer’s reductio fails. (shrink)

For years, the sexual and reproductive health of women with intellectual and developmental disability or disabilities has been insufficiently addressed by institutions and family members due to a lack of information, training, and, sometimes, religious issues. In this context, contraceptive digital pills can enhance the sexual and reproductive control of this population group. Digital pills could help to improve adherence to treatments aimed to prevent unwanted pregnancies, as well as allowing women and their caregivers to exert better drug intake control. (...) However, there are some ethical risks to consider that may outweigh these benefits. This study sets out to explore the ethical considerations that should be taken into account in the case of a potential roll‐out of contraceptive digital pills as a way of improving the sexual and reproductive health of these women. (shrink)

A number of recent legal cases in the United States have considered both disability‐based exceptions to Covid‐19‐related mask mandates and disability‐based claims to stronger masking rules in states restricting the abilities of local governments to enforce mask mandates. We argue that a proper legal and ethical analysis of such cases requires understanding the distinction between disability accommodations and disability modifications. Disability accommodations are individualized adjustments that enable qualified individuals to perform jobs or achieve access on terms comparable to those experienced (...) by others. Disability modifications are programmatic changes to structures or policies that increase accessibility. We contend that in the context of mask mandates, modifications rather than accommodations are ethically desirable because modification‐oriented policies promote disability access in a way that treats all individuals fairly, avoiding the risk of promoting misinformation and uncertainty about the health benefits of masking. (shrink)

Emergency contraception — also known as the morning after pill — is marketed and sold, under various brand names, in over one hundred countries around the world. In some countries, customers can purchase the drug without a prescription. In others, a prescription must be presented to a licensed pharmacist. In virtually all of these countries, pharmacists are the last link in the chain of delivery. This article examines and ultimately rejects several standard moves in the bioethics literature on the (...) right of pharmacists conscientiously to refuse to dispense emergency contraception. Its central thesis is that the standard ‘moderate’ solution to this problem is mistaken. Thus, when all publicly relevant interests are given their due, it is not acceptable to allow refusals in the big city, where pharmacies are plentiful, but forbid them in rural settings, where pharmacies are scarce. Rather, there should be strong public policy requiring that all pharmacists dispense emergency contraception to customers who request it, regardless of pharmacists' moral or religious objections. (shrink)

A proposed state administrative rule would have required medical ethicists to approve certain aspects of gender-affirming care. The authors argue the proposed rule lacked appropriate justification compared to other instances of state-mandated ethics oversight and would undermine trust, raise practical challenges, and send harmful messages to society, patients, and providers.

Emergency contraceptives may sometimes prevent implantation, thereby causing the death of the embryo. According to some positions contrary to abortion, because the embryo is a human animal, there are usually decisive moral reasons not to use them. In this article, I will show that objecting to the use of emergency contraceptives on those grounds is unjustified. If organisms are real existents, then according to the most plausible conception of what is required for a group of cells to compose one, the (...) embryo cannot qualify as a single organism. On the other hand, if organisms are virtual objects, then whether or not the embryo qualifies as one is morally irrelevant. I conclude that even if those positions are right about the morality of abortion, they are not entitled to oppose the use of emergency contraceptives. (shrink)

This paper examines incorrect use of oral contraceptives (OCs) in rural Bangladesh by using data from an OC compliance survey. Of the 1031 current users of OCs interviewed, about 13% took their pills out of sequence, while 17% left incorrect intervals between pill packs. Forty per cent of the women reported missing one active pill during the 6 months prior to the survey, and 74% of them took correct action with the missed pill. Of the women who missed two active (...) pills (16%), only 9% took correct action. Multivariate analyses revealed that women support helped protect against taking incorrect action with a missed pill. The fieldworker support is essential to improve the pill-taking behaviour of Bangladeshi women. (shrink)

This paper examines incorrect use of oral contraceptives (OCs) in rural Bangladesh by using data from an OC compliance survey. Of the 1031 current users of OCs interviewed, about 13% took their pills out of sequence, while 17% left incorrect intervals between pill packs. Forty per cent of the women reported missing one active pill during the 6 months prior to the survey, and 74% of them took correct action with the missed pill. Of the women who missed two active (...) pills (16%), only 9% took correct action. Multivariate analyses revealed that women's education and their husbands' support helped protect against taking incorrect action with a missed pill. The fieldworker's contact was found to protect against leaving an incorrect interval between pill packs. Women who had membership of non-government organizations were less likely to interrupt their pill use, and more likely to take their pill out of sequence. The present study underscores the need for providing women with more support in their pill use, and advocates that service providers should be the focal point of efforts. Husbands' support is essential to improve the pill-taking behaviour of Bangladeshi women. (shrink)

Political communities across the world have recently sought to tackle rising rates of vaccine hesitancy and refusal, by implementing coercive immunization programs, or by making existing immunization programs more coercive. Many academics and advocates of public health have applauded these policy developments, and they have invoked ethical reasons for implementing or strengthening vaccine mandates. Others have criticized these policies on ethical grounds, for undermining liberty, and as symptoms of broader government overreach. But such arguments often obscure or abstract away from (...) the diverse values that are relevant to the ethical justifications of particular political communities’ vaccine‐mandate policies. We argue for an expansive conception of the normative issues relevant to deciding whether and how to establish or reform vaccine mandates, and we propose a schema by which to organize our thoughts about the ways in which different kinds of vaccine‐mandate policies implicate various values. (shrink)

The magic word in Clinton's campaign had been "Change," a reorientation of policy toward the needs of the great majority of the population who had suffered from Reagan-Bush "trickle down" economics -- in practice, an upward flood -- and had swept Clinton into office on the promise of an end to the party for the rich. But it would be unfair to speak unkindly of the newly-elected President for clarifying at once that the fine words of the campaign were not (...) intended seriously, that the "Mandate for Change" proclaimed by a Clinton think tank meant "Business as Usual," as it did when Eisenhower's PR team coined the phrase. "Campaign pledges [are] made to be broken," Harvard political scientist and media specialist Marty Linsky explained when President Bush called for "revenue enhancement" after winning the 1988 election with a pledge not to raise taxes. To accuse Bush of violating his campaign pledge was a "political cheap shot." When he led the public in his "read my lips -- no new taxes" chant, Bush had merely been expressing his "world view," making "a statement of his hopes." The same precepts hold for his successor. (shrink)

: On the grounds that rape is an act of violence, not a natural act of intercourse, Roman Catholic teaching traditionally has permitted women who have been raped to take steps to prevent pregnancy, while consistently prohibiting abortion even in the case of rape. Recent scientific evidence that emergency contraception (EC) works primarily by preventing ovulation, not by preventing implantation or by aborting implanted embryos, has led Church authorities to permit the use of EC drugs in the setting of (...) rape. Doubts about whether an abortifacient effect of EC drugs has been completely disproven have led to controversy within the Church about whether it is sufficient to determine that a woman is not pregnant before using EC drugs or whether one must establish that she has not recently ovulated. This article presents clinical, epidemiological, and ethical arguments why testing for pregnancy should be morally sufficient for a faith community that is strongly opposed to abortion. (shrink)

The 2016 outbreak of the Zika arbovirus was associated with large numbers of cases of the newly-recognised Congenital Zika Syndrome. This novel teratogenic epidemic raises significant ethical and practical issues. Many of these arise from strategies used to avoid cases of CZS, with contraception in particular being one proposed strategy that is atypical in epidemic control. Using contraception to reduce the burden of CZS has an ethical complication: interventions that impact the timing of conception alter which people will (...) exist in the future. This so-called ‘non-identity problem’ potentially has significant social justice implications for evaluating contraception, that may affect our prioritisation of interventions to tackle Zika. This paper combines ethical analysis of the non-identity problem with empirical data from a novel survey about the general public's moral intuitions. The ethical analysis examines different perspectives on the non-identity problem, and their implications for using contraception in response to Zika. The empirical section reports the results of an online survey of 93 members of the US general public exploring their intuitions about the non-identity problem in the context of the Zika epidemic. Respondents indicated a general preference for a person-affecting intervention over an impersonal intervention. However, their responses did not appear to be strongly influenced by the non-identity problem. Despite its potential philosophical significance, we conclude from both theoretical considerations and analysis of the attitudes of the community that the non-identity problem should not affect how we prioritise contraception relative to other interventions to avoid CZS. (shrink)