Issues in Law & Medicine最新文献

Considerable controversy exists about the effects of medication abortion on the incidence of preterm birth (PTB). Medication abortion of various types continues to be touted as a safe alternative to surgical abortion, and without increased risk for PTB. There is a paucity of evidence regarding medication abortion and PTB, but available papers are reviewed here. There is moderate-quality evidence that medication abortions which require surgical completion increase PTB rates more than surgical abortion alone.

Self-managed abortion has been particularly prominent in recent discussions of abortion, with the rise of telemedicine abortion during the COVID-19 pandemic and the reality of self-managed illegal abortion in pro-life states following the overturning of Roe v. Wade. There has likewise been much political concern about misinformation and fake news circulated in the media. This article highlights how misinformation and poor quality studies have been used to make implausible claims regarding the safety of telemedicine and the number of deaths from unsafe abortion where abortion is illegal. This puts women's health and lives at risk by authorizing unsafe medical practice and poorly evidenced policy decisions regarding abortion and emergency obstetric care.

The Freedom of Access to Clinic Entrances Act of 1994 is no longer a valid exercise of federal jurisdiction under the Fourteenth Amendment, in light of Dobbs v. Jackson Women's Health Organization, nor ever was under the Commerce Clause, properly understood, per United States v. Morrison.

Objective: Clinicians should encourage and promote paternal involvement even in prenatal care, as this early engagement has far-reaching, positive implications on a child's life.

Summary: Men are not superfluous to the abortion process. In fact, a father's roles and responsibilities start before the act leading to conception and continue through the pregnancy, birth, and through their children's lives. This paper seeks to review evidence that these roles play an important part in a child's overall development. Additionally, this paper seeks to suggest direct approaches physicians may take to encourage constructive engagement and responsibility in fathers.

In 2020, the rules governing the practice of abortion in Poland were narrowed and became some of the strictest in Europe. These new rules were the result of the Constitutional Court's oral announcement of its judgment in case K 1/20, making abortion for embryo-pathological reasons illegal. Thus, terminations of pregnancy in cases where prenatal tests and other medical findings indicated a high risk of a severe and irreversible damage to the foetus, or an incurable life-threatening ailment of the foetus, which in 2018 accounted for approximately 98% of all abortions in Poland, were declared illegal. In the Constitutional Court's written opinion, however, the court included a statement that may constitute a basis for broader interpretation, namely, that reasons of an embryo-pathological nature, insofar as they pose a threat to the life or health of the pregnant woman, may constitute a basis for legal termination of a pregnancy on the grounds of "the mother's well-being." But it is not clear in the Court's opinion how many doctors (and of what specialties) should make the relevant evaluation that would constitute sufficient legal justification for a decision to perform a legal abortion, thereby mitigating the risk of facing legal liability for terminating a pregnancy. For these reasons, doctors are likely to bear the burden that should have been placed on the legislators, who are, after all, obliged to consistently and exhaustively consider all the factual situations that are bound to happen in medical practice. Such factual situations should be addressed by thoughtful legislation instead of subjecting physicians to potentially unorthodox or free interpretation of laws falling short of meeting the actual needs of their patients.

Background and objectives: Knowledge and competency in the topics of reproductive health and family planning are important for primary care physicians. Given the high rates of unintended pregnancy, increasing rates of infertility and other gynecologic conditions, it is important for medical students, many of whom will become primary care physicians, to receive good foundational knowledge of reproductive health topics. The objective of this research project was to investigate the current curricula at US medical schools to determine the breadth and extent of education that medical students receive in reproductive health.

Methods: Medical students and faculty at 20 US medical schools shared all relevant materials from their required reproductive health curriculum used between 2016-2019, including syllabi, PowerPoint lectures, and official class handouts that were available to all students. From these, the number of mentions of 69 reproductive health-related terms were counted, including those related to family planning methods, abortion, ectopic pregnancy, reproductive counseling, and infertility.

Results: Of the over 9000 mentions of reproductive health terms, approximately half of mentions were related to family planning, with 10% related to abortion, 10% to infertility, and 6% to reproductive counseling. Family planning strategies emphasized oral contraceptives and long-acting reversible contraceptives with limited mentions of natural or fertility awareness-based methods.

Conclusions: This data demonstrates opportunities for broadening reproductive health education in medical school so that future primary care physicians are prepared to discuss the full range of reproductive options for their patients.

Mentors are instrumental in the professional and personal growth of healthcare professionals. However, there is often reluctance to serve as a mentor due to a variety of perceived barriers. Attendees will be encouraged and empowered to engage in mentoring relationships that provide both the mentor and the mentee with a rewarding experience. This reflection will define mentoring, discuss mentoring competencies, and describe the mentoring process.

Hormonal contraceptives are widely used for birth control and therapeutic purposes. The mechanism of action proposed for these compounds can be found in several scientific journals published to date. The present work consists in a scoping review of a convenience sample of papers regarding the mechanisms of action of each of the three main classes of hormonal contraceptives available. Different parameters and biological consequences associated with their use were also reviewed. Based on these data, we evaluated the probability of embryo loss due to the use of hormonal contraceptives. Evidence indicates the probability of embryo loss due to post-fertilization effects.

Evidence in peer-reviewed literature from 168 studies over fifty years points to a causal, dose-response relationship between surgical abortion and subsequent preterm birth. This document provides an overview of this literature, discusses mechanisms for this effect, demonstrates the strength of evidence for causality, and offers guidance for informed consent prior to surgical abortion. This document does not provide detailed statistical analysis or a high-resolution assessment of the quality of studies on surgical abortion and preterm birth (covered in Practice Guideline 11).

The selective termination of one or more fetuses in higher order multiple pregnancies began in the 1980s in response to the increased rate of multiples arising from assisted reproductive technology (ART). Multifetal Pregnancy Reduction (MFPR) was justified by improving outcomes for the remaining offspring and their mother, and while the evidence suggests prematurity and the morbidity associated with it are reduced, there is a cost in increased miscarriage and mortality. As perinatal care has advanced, the margins of improvement have narrowed and hence the cost/benefit ratio. At the same time, MFPR has morphed from a rare procedure undertaken for quadruplets and higher, to one in which triplets and twins are increasingly reduced to a singleton, and more so for social reasons. This review considers the evidence for MFPR's efficacy and risks, along with those changes over time. Notably absent is research on the surviving children or the ongoing physical and mental health of mothers. The ethical reasoning used by practitioners and others is also explored, as is the culture of ART and abortion that drive the practice.