台湾人工生殖技术管制之回顾与前瞻

台湾地区人工生殖技术的管制先后经历了道德管制和行政管制两个阶段,目前正积极总结各阶段管制模式的成败得失,努力构造《人工生殖法》的原则和框架,以提高人工生殖技术管制的合法性和有效性。     

辅助生殖技术与社会公正

从生命伦理学的角度看,以解决不育问题为最初目的的辅助生殖技术,实质上是实现社会公正的一种重要手段,但现实辅助生殖技术服务却也导致了一些社会不公正现象.就此提出某些实现辅助生殖技术服务社会公正的途径有重要意义.     

Negotiating Responsibility: Case Studies of Reproductive Decision-Making and Prenatal Genetic Testing in Families Facing Huntington Disease

Three case studies are presented to further our understanding of how responsibility is negotiated in families when making decisions about genetic risk. These draw on a model of responsibility generated in a study of reproductive decision-making in families facing Huntington disease (HD) to illustrate the impact of prenatal testing on this process. This involves analyzing: how people present themselves as acting responsibly whether or not they utilize genetic testing; who they feel responsible to in their family and elsewhere; the impact that testing has on these relationships; and, how negotiating responsibility changes over time with repeated use of prenatal testing, changing risk status and maturational changes. Two key findings are: how decision-making is perceived can become as important as what is decided; and, how responsibility is negotiated depends on which of these relationships are prioritized. Implications of the findings for clinical practice are noted and suggestions made for further applications of the model.     

Reproductive ectogenesis: The third era of human reproduction and some moral consequences

In a well known story Derek Parfit describes a disconnection between two entities that normally (in real life) travel together through space and time, namely your personal identity consisting of both mind and body. Realising the possibility of separation, even if it might never happen in real life, new questions arise that cast doubt on old solutions. In human reproduction, in real life, at present the fetus spends approximately nine months inside the pregnant woman. But, we might envisage other possibilities. Historically, the first era is the normal conception inside the woman, the growth of the fetus in the womb and then, after nine months, birth and the appearance of a new individual. The second era is In Vitro Fertilisation (IVF). The fetus starts outside the woman as a fertilised egg, moves to the body of the woman and spends nine month there, where the body of the woman and the fetus travel together in space-time to separate at birth. In the third era of reproductive ectogenesis, the two never travel together. The fetus spends its gestational time entirely outside the woman’s body. We have two entities separated in space-time the whole time. The intimate connection consisting in the fetus being a part of the woman’s body is gone. In this paper I will briefly comment on the three eras of human reproduction — and primarily on the relationship between the new individual and the woman — and then spend some time with a fictional story illustrating some moral consequences of the third era. The story is from Pig Pharmaceuticals Limited and how they in the year 2050 report the successful development of pig-related pregnancies with transgenic pigs as surrogate mothers.     

Embryo genetic disorder analysis demonstration project: A model protocol

A demonstration project designed for couples at a minimum 25% risk for having a child with cystic fibrosis is being undertaken using embryo genetic disorder analysis within an organization proficient inin vitro fertilization techniques. Prior to offering the project to patients, issues were identified that needed to be addressed in order to improve the likelihood of success. We then developed a set of protocols that would enable us to introduce this new technology to our staff and to prospective patients in a consistent manner.     

Genetic Counseling, Reproductive Behavior and Future Reproductive Intentions of People with Neurofibromatosis Type 1 (NF1)

Neurofibromatosis type 1(NF1) is a complex and variable inherited disorder. The complexity and variability present particular difficulty for genetic counseling. Thirty-three people with NF1 of reproductive age were interviewed about their experience of genetic counseling, their past reproductive behavior and future intentions. One third reported having had no genetic counseling or not having it until after their first child. In part, this may be due to delay in diagnosis but also indicates poor access to genetic services. Only three people had ever been offered prenatal genetic testing and only one had accepted. Although testing is still technically difficult, the greatest deterrent to uptake of prenatal testing for NF1 is the variability of the disorder. However, six of the 17 people planning future pregnancies would want a test with a view to termination if necessary. Others would welcome testing in order to be prepared but not to terminate. We discuss some of the factors which influence reproductive decision making for people with NF1 and some of the difficulties in genetic counseling in such a variable and complex disorder.     

Postpartum Depression Among Women With Disabilities: A Multicultural Counseling Perspective

Postpartum depression is an important mental health problem for women, and women with disabilities are at greater risk than are women without disabilities. This article explores the disability‐specific contextual, environmental, social, and systemic causes of postpartum depression from an ecological perspective. I aim to help counselors develop a nonpathologizing, multicultural counseling–rooted approach and to prepare counselors to work effectively with this unique population. Implications of multicultural counseling tenets and advocacy are also examined for best practices. La depresión posparto es un problema de salud mental importante para las mujeres, y el riesgo es mayor para las mujeres con discapacidades que para las mujeres sin discapacidades. Este artículo explora las causas contextuales, sociales, del entorno y sistémicas de la depresión posparto relacionadas con la discapacidad desde una perspectiva ecológica. Mi objetivo es ayudar a los consejeros a desarrollar un enfoque no patológico basado en la consejería multicultural y preparar a los consejeros para trabajar de forma efectiva con esta población singular. También se examinan las implicaciones de los principios de la consejería multicultural y la defensoría para las prácticas recomendadas.     

分离遗传与环境对儿童发展的影响：介绍一个新颖的研究方法

本文介绍一个可以用于研究遗传与环境互动的新颖方法。此研究收集了上千个4~10岁儿童的数据。这些儿童的出生都借助于不同的辅助受孕技术（Assisted Reproductive Technologies）,包括试管婴儿、精子捐赠、卵子捐赠、胚胎捐赠及代孕技术。本项目通过妇科（助孕）医院收集被试的行为数据,包括家庭互动、养育方式、父母婚姻质量、家庭成员的心理健康及经济状况等。本文选择性地介绍一些分析的结果,以彰显这种设计在分离遗传和产前产后环境对儿童发展的贡献。首先,我们比较了“助孕”儿童与“自然孕”儿童在父母冲突、父母对子女敌意以及儿童抑郁症状之间关系的异同。其次,我们比较了这两组儿童在父母抑郁症状、家庭关系质量以及儿童抑郁症状之间关系的异同。再次,本文介绍了这一可分离遗传与环境因素的研究设计。最后,我们讨论了这一设计对发展心理病干预及预防的意义     

Psychological interventions for infertile patients: a review of existing research and A new comprehensive approach

The usefulness of psychological support for infertile patients has been highlighted in the literature over the past number of years. This article provides a review of existing research on psychological interventions for infertile patients, and presents the Fertility Group Intervention as an example of the application of existing research. There is clear empirical evidence of high levels of depressive symptoms, anxiety, and distress among infertile patients undergoing assisted reproductive treatment (ART). Infertile patients need and require increased psychological support. Various studies indicate the efficacy of psychological interventions for infertile patients with respect to their mental health and, in part, pregnancy rates. However, many such studies exhibit methodological problems. Therefore, in future research, additional studies of high‐quality design are needed to achieve more definitive answers on the efficacy and indication of psychological interventions for infertile patients. Currently, the Fertility Group Intervention represents a comprehensive therapeutic approach integrating established empirical and theoretical approaches with the aim of helping infertile patients – particularly those undergoing ART – cope with distress related to their infertility and medical treatment. This article further outlines the therapeutic background and structures, treatment goals, practical implications, and feasibility of the Fertility Group Intervention.     

生育健康的伦理学基础:个人本位还是社会本位

随着“以妇女为中心”生育健康概念的提出,女性的健康与他们在社会中享有权利的关系正引起人们的关注。然而,如何实现女性有生育过程中的主体地位,解决她们所面临的与社会选择的矛盾,在很大程度上取决于特有的社会伦理背景以及所遵循的价值原则。由于中国与西方的社会伦理发展轨迹的差异,构建生育健康的伦理框架和强调女性生育自主权的努力方向也应异于西方。