498 e-Letters

  • A general response to the rapid response section

    While I do understand why some people may have strong sentiments towards this published article, I do find it interesting how most of them are not morally backed. This is a philosophical discussion and I believe that in order to make your point known you should be able to use moral principles to respond to the article.

    In order to discuss this question we must separate whether we should do something and whether something is morally wrong. For example, we should not speed on a highway, yet it is not morally wrong provided that we do not harm others' interest. At the same time, killing animals for meat is morally wrong, yet we still do it for various reasons. Here, I argue for the author that there is no moral difference between a fetus and a infant in moral status, yet we should not be allowed to kill an infant because it will inevitably lead to multiple complications that our society and legal system may not be ready to face. One of such issue is that it is hard to draw the line between a baby with personhood and a baby without, since it is a continuous process. The legalization of this may also lead to other issues such as the permissibility of killing severely mentally impaired adults (as they do not have a personhood either).

  • Ride the horse in the direction its going.

    There seems to be a disconnect between Dr. Pennings and the decades of reporting of actual experiences of parents, donors and donor-conceived people.

    The first argument is that there is no evidence that a change in age will increase the total well-being of donor offspring as a group. 

    There is plenty of published research and years of anecdotal evidence. We invite Dr. Pennings to read not only the research, (https://indd.adobe.com/view/ac2a0b99-f67a-4768-bf8c-c48af5aeebaf) but also the reported experiences of more than 86,000 over the past 22 years on the www.DonorSiblingRegistry.com website. Many thousands of these donor-conceived people (DCP) have connected with their biological parent (donor) long before the age of 18.  Many more DCP have made their stories public in hopes of shining a light on the innate human desire to know who and where we come from. Many formerly anonymous egg and sperm donors who have connected with donor children have participated in research and have also made their stories public.  Additionally, several dozen egg clinics, agencies, and lawyers have been writing the Donor Sibling Registry into their parent-donor agreements for many years, connecting donors and parents right from pregnancy/birth. This is an extremely popular and successful program empowering donors and parents to decide the depth, breadth,...

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  • Why an Age Restriction Doesn't Work

    I thank Dr. Pennings for his thoughtful work. There are, however, further critical points to be considered when designating any arbitrary age by which a donor conceived person (DCP) can learn the identity of his/her donor. Although I agree that outcome research needs to be conducted on DCP stratified by the age at which they specifically learn their donors identities, the existing research on adoption, which parallels many of the ethical and humanistic aspects of donor conception, largely supports the idea of open adoption, where all parties are knowledgeable of the others at birth. According to one recent review, contact with the birth family results in substantially more positive outcomes for adoptees (Smith et al, 2020). Research has also shown significantly greater benefit for the adoptive parents and birth mothers in terms of satisfaction with the adoption process and post-partum adjustment in open adoption (Ge et al, 2008). This study also indicates positive experience in the new kinds of relationships created through open adoption, and the authors extend the implications of their findings to reproductive technologies such as donor conception as well.

    The practicalities of enforcement of a designated age where DCPs might be permitted to learn their donor's identities also must be addressed. DCPs learning the identity of their donor through commercial DNA testing prior to the designated age is only one consideration. A second ethical dilemma would b...

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  • Access to Genetic Identity from Birth Is in the Best Interest of a Child and is Not "Bionormative"

    In the U.S. a parent has a fundamental right to raise their child as they see fit, but this not an absolute right. Parents must act in the best interest of their child. The right to know your genetic identity is supported by ethical principles and existing legal frameworks. Denying individuals access to their genetic information violates their autonomy, privacy, and dignity. Lack of access to genetic identity information from birth also significantly increases the likelihood of physical and mental health issues.

    Medical history and genetic makeup play an essential role in identifying health risk factors. An accurate medical history provides relevant information to the genetic information stored in our DNA. Family health history is a significant factor in determining the likelihood of developing certain diseases we carry in our DNA. Family medical history includes the types of health conditions family members have been diagnosed with, age of diagnosis, and relevant environmental or lifestyle factors. Common health conditions often included in a family medical history are heart disease, cancer, stroke, diabetes, high blood pressure, and mental health disorders.

    A thorough understanding of medical history can help identify early signs of conditions that may otherwise go undetected. People base their health habits on their parents’ medical history which could, if incorrect, lead to medical conditions that might have been prevented, delays in diagnosis, or unnece...

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  • Decision to test is a medical one

    Dear Editor,

    Brain death remains a much discussed and perhaps even a controversial topic since its inception in 1968. It is good to see an addition to this debate in the form of an article on “Consent to testing for brain death” (1). The authors of this article note lack of uniformity of this construct across different jurisdictions which, despite reasonably strict codes of practice and different legal frameworks, implies that brain death is perhaps as much social or legal as biological concept. The elephant in the room however, as far as this article is concerned, is the lack of consent when admitting to ICU in the first place. There is an overarching duty to protect life even though prior values are not known at the outset of treatment. Consent in the UK can only be provided by an adult with capacity. Otherwise, treatment is provided based on the best interests framework. Consent on someone’s behalf is not possible in this jurisdiction. The authors repeatedly point out the invasiveness of brain death testing and distress of apnoea testing omitting to highlight the invasiveness of ICU care and distress associated with ventilatory or other interventions. Furthermore, the argument being made about moral distress misses the point: the distress is about ongoing interventions in the face of catastrophic brain injury to which formal diagnosis of death puts an end. Religious and conceptual barriers to withholding critical care interventions can be overcome even in most d...

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  • One cheer for trust

    Eyal is correct that ethicists’ speculations about how the public may respond to human challenge trials are often made without a whisper of evidence.

    This is not a new problem. The Institute of Medicine titled a 2001 monograph Preserving Public Trust: Accreditation and Human Research Participant Protection Programs. One might think that a book with this title would demonstrate that the IRB system preserves public trust, but the title is merely an ornamental flourish. The book is devoted entirely to the accreditation of IRBs; public trust is neither analyzed in depth nor is there any attempt to show that accreditation improves trust.

    We all agree that trust is important, which is what earns it one cheer. Assertions about its future trajectory merit additional applause only when they are are supported by evidence.

    Cite: Institute of Medicine (U.S.). Committee on Assessing the System for Protecting Human Research Subjects. 2001. Preserving Public Trust: Accreditation and Human Research Participant Protection Programs. Washington, D.C.: National Academy Press.

  • Disease is not a metaphor we should use

    Smajdor and Räsänen's comparison of other human beings (those yet to be born) with pathogens or cancer has troubling historical antecedents. It reflects an undesirable coarsening of the debate around medical care in pregnancy, and does not reflect the lived experience of most women towards the children they bear.

    Hospitality provides a far better metaphor for pregnancy than disease. It focuses on our duty to support those who are unexpectedly or even reluctantly in the position of accommodating someone else in need.

  • The proportionality principle is the wrong ethical standard for vaccine mandates

    The article does not engage with the objections (published in this journal and also in response to the previous article by the same lead author) to the applicability of the ‘proportionality principle’ to ethical judgment when the considered intervention violates the right to life and discriminates on the basis of healthy, innate biological characteristics of the human race. In particular, the proportionality principle is irrelevant to coercive policies (mandates) if the associated procedure is known to kill a small percentage of people and therefore amounts to a mandated killing of a minority for the benefit of the majority. The right to life cannot be taken away in the interests of others, even if the majority would greatly benefit from the killing, without negating the very concept of human rights: if being born human is not a guarantee of the right to life, then there is no right to life. On this view, vaccination mandates can no longer be considered healthcare but democide.



  • Need to consider other benefits of COVID-19 vaccine boosters in university students

    We read with interest this risk-benefit and ethical analysis of the utility of SARS-CoV-2 vaccine boosters in university students. We have some major concerns about the choice of hospitalization as the primary measure of benefit. From the onset of the pandemic, healthcare providers, scientists, and public health experts in higher education have been learning from shared experiences, research, and evolving medical knowledge about the best way to safely populate college campuses with students, faculty, and staff. Hospitalizations averted is not the only marker of morbidity that is relevant to the college student population and given the rarity of severe disease requiring hospitalization in young, generally very healthy adults, hospitalization is not a good choice for a marker of COVID-19 related morbidity. We have also strived to minimize the risk of missed classes, severe illness, and need for prolonged medical leaves of absence given the potential adverse academic consequences of illness for students. Colleges and universities have been trying to balance infectious disease mitigation efforts with the need for in-person learning, social interactions, and the increased mental health challenges caused by some of these efforts that furthered the experience of isolation.

    Much has changed since early 2020 and most schools have continued to evolve their protocols and policies to reflect new information and relevant data. We are dedicated to learning and contributing to th...

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  • Mandating Uncertainty

    "The will of the people shall be the basis of the authority of government".Article 21 of the United Nations' 1948 Universal Declaration of Human Rights
    The most recent feature article by Bardosh et al opposes policies requiring vaccination with SARS Cov-2 mRNA vaccines in order to matriculate at universities in the United States (1). While the exposition put forward is thorough and cogent, the article raises a much larger question dealing with forced vaccination to prevent illness in our population. Vaccination has been enormously successful in dealing with a host of human diseases (2-4). One cannot overstate the huge benefits to humanity accruing from prevention of viral diseases including smallpox, rabies, yellow fever, measles, mumps, rubella, varicella and, of course, paralytic polio. Recently developed vaccines protect against hepatitis A and B. Human papilloma virus vaccine may succeed in reducing the cancer burden in women and also in men. Typhoid, tetanus, diphtheria, pertussis, hemophilus, meningococcus, and pneumococcus vaccines have been highly successful in dealing with these bacterial pathogens (5).
    All states require children to be vaccinated against certain communicable diseases as a condition for school attendance
    That is understandable since school brings together a large number of individuals in very close proximity. Certainly colleges with the inevitable crowded living conditions in dormitories promote a 24 hour expo...

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