Forum 2016 Workshops
Changing fertility: social, demographic and ethical consequences of assisted conception technologies - 23 May 2016
Convenors: Professor Sarah Franklin (Sociology) and Dr Nitzan Peri-Rotem (Sociology)
The Changing Fertility Forum, an event jointly organized by the Philomathia Programme and the Reproductive Sociology Research Group (ReproSoc) was held this spring at the University of Cambridge. The forum has set the scene for an exploration of recent changes in fertility patterns in industrialized societies and the way these are related to the widening use of assisted reproductive technologies (ART). This international event has brought together health professionals, members of non-governmental organizations and academics from various disciplines, including history, sociology, anthropology, demography, public health, law and philosophy. This yielded a truly unique conversation between different parties that seldom have the opportunity to exchange ideas, a conversation that enabled us to put together some of the pieces of the changing fertility puzzle.
The two presentations in the first session provided some insights about the different aspects of ART use, from the initial causes of infertility to demographic outcomes of assisted reproduction. Lone Schmidt, an Associate Professor at the University of Copenhagen, discussed this issue from a public health perspective, addressing questions such as how infertility is defined? How widespread is it among women, men and couples? And what are the causes and risk factors of infertility? Schmidt noted that although infertility is considered a disease by the World Health Organization, there are no national preventative strategies to deal with it. Moreover, even the best assisted reproduction technologies are not sufficient to overcome reduced fertility as a result of advanced female age.
Tomas Sobotka, a Senior Researcher from the Vienna Institute of Demography, has described the different social and economic reasons for fertility postponement in developed countries, including prolonged education, increased economic insecurity and less stable relationships. Thus, while it is biologically optimal for women to start a family when they are in their early or mid-20s, this does not always match their social circumstances. These presentations raised many questions regarding, among other things, the slippery concept of infertility, the extent to which the timing of childbirth is a matter of choice and the appropriate policy response to these issues. One of the main propositions stressed in the forum was that infertility should be addressed from a more structural and holistic viewpoint, taking into account the process in which reproductive decisions are made and the factors that affect these decisions. Therefore, delayed childbearing should be understood not only as a private matter, but as a socially and economically dependent choice.
For more details, see: http://www.reprosoc.sociology.cam.ac.uk/blog-and-podcasts/blog/changing-fertility
Legal regulation of the transplantation of suboptimal organs - 11 April 2016
Convenors: Dr Kourosh Saeb-Parsy (Transplant Unit), Dr Matthew Dyson (Law) and Dr Kathleen Liddell (Law)
Organised by a team drawn from Cambridge’s Transplant Unit and the University’s Law Faculty, this workshop examined legal liability for adverse outcomes following transplantation of suboptimal organs. Participants included leading specialists in transplantation, law, health psychology, ethics and policy.
Due to a shortage of suitable organs and the growing number of patients dying on transplant waiting lists, the use of less-than-ideal organs from deceased donors is becoming more common. ‘Suboptimal’ organs include organs from older donors or those with co-morbidities, infections, current or previous cancers, or history of high risk behaviour such as smoking, excessive alcohol intake and illicit drug use. The outcomes from transplantation of such suboptimal organs are generally acceptable for the patient population compared with the even greater risk of death while waiting for an organ. However, compared with optimal organs, sub-optimal organ transplantations expose individual patients to greater risk of transmission of disease and major morbidity, graft loss or death. Recent adverse outcomes – including the death of two kidney recipients - raise questions about the potential for surgeons to be held liable for using suboptimal rather than standard or optimal organs. These liability issues raised related questions about the appropriateness of current legal ‘checks and balances’ on pre-mortem interventions (such as pre-mortem heparinisation) which might improve organ quality.
The workshop built on the organisers’ publication in the Lancet (2015; 386: 719-21). Specifically it sought to generate more detailed debate and develop policy proposals on the following issues:
The reasons for, and challenges of, using marginal organs in transplantation;
The legal framework for adverse outcomes of suboptimal organ transplantation with a special focus on the torts of negligence and product liability;
The desirability of relying on tort law to regulate the use of suboptimal organs;
Whether the legal system currently imposes appropriate checks and balances to address the risks of pre-mortem interventions for donors (and their families), alongside the opportunity to improve organ quality for recipients;
International perspectives on organ transplantation and the legal regulation of it.;
Future research and policy directions.
Following the Workshop, the organisers presented their views on these issues at an international conference in Rome: Ethical, Legal and Psychosocial Aspects of Transplantation.
The organisers are immensely grateful to everyone who participated on the day, and to the Philomathia Foundation for funding the event.