Early cognitive development in children born to women with epilepsy: a prospective report.

PURPOSE: In this prospective study the early cognitive development of children born to women with epilepsy (n = 198) was assessed and compared to a group of children representative of the general population (n = 230). METHODS: The children were assessed when younger than the age of 2 years using the Griffiths Mental Development Scales, either in their local participating hospital or in their home. The assessments were completed by an assessor who was blinded to whether the child's mother had epilepsy and to antiepileptic drug type. RESULTS: Children exposed to sodium valproate had a statistically significant increased risk of delayed early development in comparison to the control children. Linear regression analysis showed a statistically significant effect of sodium valproate exposure on the child's overall developmental level that was not accounted for by confounding variables. Delayed early development is also noted for children within an ad hoc group of less commonly utilized antiepileptic drugs, although conclusions cannot be drawn due to the size of this group (n = 13). Children exposed to either carbamazepine or lamotrigine in utero did not differ significantly in their overall developmental ability. Differences noted in specific developmental areas for these two groups were not statistically significant after the control for confounders such as socioeconomic status and maternal IQ. DISCUSSION: Women with epilepsy should be informed of the risks posed to their potential offspring prior to pregnancy to allow for informed decisions regarding treatment. Children exposed in utero to antiepileptic drugs should be monitored throughout childhood to allow for early intervention when necessary.

Is emergency contraception murder?

Hormonal emergency contraception (EC) is engendering fierce moral disagreement that is bleeding over into politics and policy. This paper considers Catholic positions on this issue, as they are the fullest and best developed. Its most extreme opponents, such as representatives of the Vatican, hold that EC is an abortifacient that should be banned. Moderates like Sulmasy believe that it should be available to women who have been raped when a negative pregnancy test suggests that fertilization has not yet taken place, and liberals, like Catholics for Free Choice, believe that it should be available to all women regardless of its mode of action. These positions depend in part on underlying philosophical presuppositions about when valuable life begins and scientific assumptions about how EC works. I argue that there are good reasons for rejecting the criterion of fertilization, and that the best current evidence strongly suggests that EC has no post-fertilization effects. These points by themselves undermine key objections to EC. I also show that none of the remaining considerations are sufficiently compelling to warrant overriding women's right to exercise religious, moral, and political agency in preventing undesired pregnancies.

What religious ethics can and cannot tell us about reproduction and sexuality.

The Religious Right movement maintains that only sexual activity open to reproduction is morally acceptable, and that violating this imperative violates God's will. Religious progressives and secular humanists deny these positions, arguing instead that the moral quality of sex is determined by how its participants treat each other. However, religious progressives (but not secular humanists) continue to believe that religion has some authority in ethics. This paper shows why no such arguments are successful, and concludes that any compelling case against the Religious Right sexual ethic and in support of a humane one must be based in secular ethics.

Is preconception sex selection necessarily sexist?

The advent of sperm sorting opens up the possibility that sex selection could become much more easily accessible, raising many moral questions. Two fundamental issues are whether sex selection is necessarily sexist and whether it should be highly regulated or banned on those grounds. I argue that, in some societies, sex selection of males is clearly sexist and that it promotes and reinforces extreme sexism. Extreme sexism seriously harms women, and if, in the opinion of those who know the situation best, prohibition is the best strategy for protecting women, a ban can be reasonable. In other societies, there may not be a pronounced preference for males, and sex selection may be neither particularly harmful nor even sexist. In those cases, there is no obvious benefit from prohibition, and prohibition may even represent a risk to women's reproductive autonomy.

Are pregnant women fetal containers?

KIE: Purdy explores the argument that women's rights to control their bodies should be subordinated to the welfare of their fetuses. She gives examples ofinstances where women's decisions about pregnancy and childbirth have been overridden by physicians and judges. She examines the nature of the mother fetus relationship, the social context of the current conflict between maternal and fetal rights, and the extent of a woman's legally enforceable duty to her fetus. Purdy acknowledges that women may owe a reasonable duty to their fetuses to try to prevent disease or handicap. However, given the uncertainties of modern medicine, the value-laden nature of many physicians' decisions, and the lack of adequate adequate prenatal care, women should not be held responsible for situations that are due largely to society's shortcomings. Purdy concludes that it is unjust to use the law to coerce women into accepting medical advice.^ieng

Surrogate mothering: exploitation or empowerment?

KIE: The morality of surrogate mothering is analyzed from a "consequentialist" framework which attempts to separate those consequences that invariably accompany a given act from those that accompany it only in particular circumstances. Critics of surrogacy argue that it transfers the burden and risk of pregnancy onto another woman, separates sex and reproduction, and separates reproduction and childrearing; none of these acts is necessarily wrong, either morally or for women's or society's basic interests. While surrogate mothering can be rendered immoral if women are coerced into the practice or become victims of subordinating or penalizing contracts, it has the potential to empower women and increase their status in society by providing a job that is less risky and more enjoyable than other jobs women are forced to take and by achieving greater social recognition for reproductive labor.^ieng

A response to Dodds and Jones.

KIE: In response to "Surrogacy and Autonomy," by Susan Dodds and Karen Jones in this issue of Bioethics, the author concedes that only a surrogacy practice stringently regulated by good counseling, escape clauses for pregnant women, and the prohibition of profit-making agencies will save women from exploitation, but she objects to singling out women for paternalistic "protection against themselves," and to defending women's autonomy to the extent of their right to behave in ways known to harm a fetus. Dodds and Jones' concerns about attitudes toward women, genetic bias, the concept of children as property, and the harm principle generated by surrogacy contracts are answered with arguments for why surrogacy should not be illegal.^ieng