Thesis (doctoral)--Universität, Düsseldorf, 2005. / Includes bibliographical references (p. [387]-423).

Introdução: As consultorias de Bioética Clínica auxiliam no processo de reflexão para a tomada de decisão dos profissionais, dos pacientes ou das famílias quando surge algum problema ou conflito ético durante o atendimento assistencial. As relações familiares dos pacientes podem estar envolvidas nestas situações, inclusive de forma a dificultá-la. Objetivos: Avaliar a presença e a influência das famílias nas consultorias de Bioética Clínica. Assim como, estabelecer o perfil das consultorias nas quais as relações familiares dificultaram a resolução do problema ou conflito ético, quanto aos solicitantes, às especialidades, aos registros em prontuários eletrônicos, aos pacientes e às relações familiares. Métodos: Foram avaliados 307 registros de consultoria de Bioética Clínica, por demanda assistencial, realizadas pelo Serviço de Bioética do Hospital de Clínicas de Porto Alegre de 2010 a 2011. Os dados foram coletados a partir dos registros do Serviço de Bioética e dos prontuários eletrônicos dos pacientes. Foram excluídas as consultorias proativas realizadas nos Rounds Clínicos regulares das equipes assistenciais, as reuniões do Serviço de Bioética e do Comitê de Bioética Clínica. Para análise qualitativa foi utilizada a Análise de Conteúdo e a classificação de Nelson e Nelson, de sete aspectos para as relações familiares. A avaliação quantitativa foi feita por meio de medidas descritivas e por associações, utilizando o programa SPSS 18.0. Resultados: Em 57% dos 307 registros de consultoria avaliados as relações familiares dos pacientes estavam envolvidas, predominantemente (38%) dificultando a resolução do problema ou conflito ético. Destas consultorias, cujas famílias agregaram dificuldades (n=116), 71% das consultorias foram geradas por solicitações de médicos. Os serviços de Medicina Interna, Pediatria e Psiquiatria demandaram 56% das consultorias. Em 79% dos registros foi possível identificar os prontuários dos pacientes associados. Quanto a resposta, 71% das consultorias foram atendidas no mesmo dia ou no dia seguinte à sua solicitação. Quando às características dos pacientes, a distribuição em relação ao sexo foi equilibrada, com predomínio da faixa etária adulta, e 54% eram procedentes de Porto Alegre. As relações familiares naturalmente impostas foram as mais identificadas (72%). Nestas mesmas 116 famílias foram identificados os sete aspectos das relações familiares: intimidade; não substituição; motivos; responsabilidade; vínculos; enredos familiares e modelagem. Conclusão: A compreensão da presença e da influência das famílias, principalmente quando estas dificultam a resolução do problema ou conflito ético, a identificação do perfil destas consultorias, bem como a reflexão sobre os aspectos das relações familiares, pode ampliar as possibilidades de avaliar os casos de Bioética Clínica e de planejar estratégias institucionais que envolvem o processo de tomada de decisão no atendimento assistencial. / Introduction: Clinical Bioethics consultants assist professionals, patients or families in the reflection of decision-making process when a problem or ethical conflict arises during assistance services. Family relationships of patients may be involved in these situations, including how to hinder it. Objectives: To evaluate the presence and influence of families in Clinical Bioethics consultations. As well to establish the consulting profile in which family relationships difficult to resolve the problem or ethical conflict: applicants, specialty, records in electronic medical records, patients and family relations. Methods: We analyzed 307 records of Clinical Bioethics ondemand assistance consultations, conducted by the Bioethics Division, Hospital de Clinicas de Porto Alegre from 2010 to 2011. Data were collected from the records of the Bioethics Division and electronic medical records of patients. Were excluded proactive consultancies carried out in regular Clinical Rounds of healthcare, the regular meetings of the Division and the meetings of Clinical Bioethics Committe. For qualitative analysis was used content analysis and classification of seven aspects for family relationships (Nelson and Nelson). The quantitative evaluation was performed by descriptive measures and associations, using SPSS 18.0. Results: In 57% of the 307 records of family relations consultant evaluated the patients involved were predominantly (38%) making it difficult to resolve the problem or ethical conflict. These consultancies, whose families have added difficulties (n = 116), 71% of consultations were generated by requests from physicians. Internal Medicine, Pediatrics and Psychiatry Services demanded 56% of consultants. In 79% of the records was possible to identify patient records associated with it. As for response, 71% of consultations were seen on the same day or the day after your request. The patient characteristics, distribution in relation to gender, was balanced, with a predominance of adult age group and 54% were from Porto Alegre. Family relationships identified as naturally imposed were the most predominant (72%). In the same 116 families were identified the seven aspects of family relationships: Intimacy, Not Replacement, Reasons, Responsibility, Links, Family Plots and Modeling. Conclusion: The understanding of the presence and influence of families, especially when they hinder the resolution of the problem or ethical conflict, identifying the profile of these consultants, as well as reflections on aspects of family relationships, can extend the possibilities to assess cases of Clinical Bioethics and institutional policies that involve the process of decision making in health care services.

Introdução: As consultorias de Bioética Clínica auxiliam no processo de reflexão para a tomada de decisão dos profissionais, dos pacientes ou das famílias quando surge algum problema ou conflito ético durante o atendimento assistencial. As relações familiares dos pacientes podem estar envolvidas nestas situações, inclusive de forma a dificultá-la. Objetivos: Avaliar a presença e a influência das famílias nas consultorias de Bioética Clínica. Assim como, estabelecer o perfil das consultorias nas quais as relações familiares dificultaram a resolução do problema ou conflito ético, quanto aos solicitantes, às especialidades, aos registros em prontuários eletrônicos, aos pacientes e às relações familiares. Métodos: Foram avaliados 307 registros de consultoria de Bioética Clínica, por demanda assistencial, realizadas pelo Serviço de Bioética do Hospital de Clínicas de Porto Alegre de 2010 a 2011. Os dados foram coletados a partir dos registros do Serviço de Bioética e dos prontuários eletrônicos dos pacientes. Foram excluídas as consultorias proativas realizadas nos Rounds Clínicos regulares das equipes assistenciais, as reuniões do Serviço de Bioética e do Comitê de Bioética Clínica. Para análise qualitativa foi utilizada a Análise de Conteúdo e a classificação de Nelson e Nelson, de sete aspectos para as relações familiares. A avaliação quantitativa foi feita por meio de medidas descritivas e por associações, utilizando o programa SPSS 18.0. Resultados: Em 57% dos 307 registros de consultoria avaliados as relações familiares dos pacientes estavam envolvidas, predominantemente (38%) dificultando a resolução do problema ou conflito ético. Destas consultorias, cujas famílias agregaram dificuldades (n=116), 71% das consultorias foram geradas por solicitações de médicos. Os serviços de Medicina Interna, Pediatria e Psiquiatria demandaram 56% das consultorias. Em 79% dos registros foi possível identificar os prontuários dos pacientes associados. Quanto a resposta, 71% das consultorias foram atendidas no mesmo dia ou no dia seguinte à sua solicitação. Quando às características dos pacientes, a distribuição em relação ao sexo foi equilibrada, com predomínio da faixa etária adulta, e 54% eram procedentes de Porto Alegre. As relações familiares naturalmente impostas foram as mais identificadas (72%). Nestas mesmas 116 famílias foram identificados os sete aspectos das relações familiares: intimidade; não substituição; motivos; responsabilidade; vínculos; enredos familiares e modelagem. Conclusão: A compreensão da presença e da influência das famílias, principalmente quando estas dificultam a resolução do problema ou conflito ético, a identificação do perfil destas consultorias, bem como a reflexão sobre os aspectos das relações familiares, pode ampliar as possibilidades de avaliar os casos de Bioética Clínica e de planejar estratégias institucionais que envolvem o processo de tomada de decisão no atendimento assistencial. / Introduction: Clinical Bioethics consultants assist professionals, patients or families in the reflection of decision-making process when a problem or ethical conflict arises during assistance services. Family relationships of patients may be involved in these situations, including how to hinder it. Objectives: To evaluate the presence and influence of families in Clinical Bioethics consultations. As well to establish the consulting profile in which family relationships difficult to resolve the problem or ethical conflict: applicants, specialty, records in electronic medical records, patients and family relations. Methods: We analyzed 307 records of Clinical Bioethics ondemand assistance consultations, conducted by the Bioethics Division, Hospital de Clinicas de Porto Alegre from 2010 to 2011. Data were collected from the records of the Bioethics Division and electronic medical records of patients. Were excluded proactive consultancies carried out in regular Clinical Rounds of healthcare, the regular meetings of the Division and the meetings of Clinical Bioethics Committe. For qualitative analysis was used content analysis and classification of seven aspects for family relationships (Nelson and Nelson). The quantitative evaluation was performed by descriptive measures and associations, using SPSS 18.0. Results: In 57% of the 307 records of family relations consultant evaluated the patients involved were predominantly (38%) making it difficult to resolve the problem or ethical conflict. These consultancies, whose families have added difficulties (n = 116), 71% of consultations were generated by requests from physicians. Internal Medicine, Pediatrics and Psychiatry Services demanded 56% of consultants. In 79% of the records was possible to identify patient records associated with it. As for response, 71% of consultations were seen on the same day or the day after your request. The patient characteristics, distribution in relation to gender, was balanced, with a predominance of adult age group and 54% were from Porto Alegre. Family relationships identified as naturally imposed were the most predominant (72%). In the same 116 families were identified the seven aspects of family relationships: Intimacy, Not Replacement, Reasons, Responsibility, Links, Family Plots and Modeling. Conclusion: The understanding of the presence and influence of families, especially when they hinder the resolution of the problem or ethical conflict, identifying the profile of these consultants, as well as reflections on aspects of family relationships, can extend the possibilities to assess cases of Clinical Bioethics and institutional policies that involve the process of decision making in health care services.

Introdução: As consultorias de Bioética Clínica auxiliam no processo de reflexão para a tomada de decisão dos profissionais, dos pacientes ou das famílias quando surge algum problema ou conflito ético durante o atendimento assistencial. As relações familiares dos pacientes podem estar envolvidas nestas situações, inclusive de forma a dificultá-la. Objetivos: Avaliar a presença e a influência das famílias nas consultorias de Bioética Clínica. Assim como, estabelecer o perfil das consultorias nas quais as relações familiares dificultaram a resolução do problema ou conflito ético, quanto aos solicitantes, às especialidades, aos registros em prontuários eletrônicos, aos pacientes e às relações familiares. Métodos: Foram avaliados 307 registros de consultoria de Bioética Clínica, por demanda assistencial, realizadas pelo Serviço de Bioética do Hospital de Clínicas de Porto Alegre de 2010 a 2011. Os dados foram coletados a partir dos registros do Serviço de Bioética e dos prontuários eletrônicos dos pacientes. Foram excluídas as consultorias proativas realizadas nos Rounds Clínicos regulares das equipes assistenciais, as reuniões do Serviço de Bioética e do Comitê de Bioética Clínica. Para análise qualitativa foi utilizada a Análise de Conteúdo e a classificação de Nelson e Nelson, de sete aspectos para as relações familiares. A avaliação quantitativa foi feita por meio de medidas descritivas e por associações, utilizando o programa SPSS 18.0. Resultados: Em 57% dos 307 registros de consultoria avaliados as relações familiares dos pacientes estavam envolvidas, predominantemente (38%) dificultando a resolução do problema ou conflito ético. Destas consultorias, cujas famílias agregaram dificuldades (n=116), 71% das consultorias foram geradas por solicitações de médicos. Os serviços de Medicina Interna, Pediatria e Psiquiatria demandaram 56% das consultorias. Em 79% dos registros foi possível identificar os prontuários dos pacientes associados. Quanto a resposta, 71% das consultorias foram atendidas no mesmo dia ou no dia seguinte à sua solicitação. Quando às características dos pacientes, a distribuição em relação ao sexo foi equilibrada, com predomínio da faixa etária adulta, e 54% eram procedentes de Porto Alegre. As relações familiares naturalmente impostas foram as mais identificadas (72%). Nestas mesmas 116 famílias foram identificados os sete aspectos das relações familiares: intimidade; não substituição; motivos; responsabilidade; vínculos; enredos familiares e modelagem. Conclusão: A compreensão da presença e da influência das famílias, principalmente quando estas dificultam a resolução do problema ou conflito ético, a identificação do perfil destas consultorias, bem como a reflexão sobre os aspectos das relações familiares, pode ampliar as possibilidades de avaliar os casos de Bioética Clínica e de planejar estratégias institucionais que envolvem o processo de tomada de decisão no atendimento assistencial. / Introduction: Clinical Bioethics consultants assist professionals, patients or families in the reflection of decision-making process when a problem or ethical conflict arises during assistance services. Family relationships of patients may be involved in these situations, including how to hinder it. Objectives: To evaluate the presence and influence of families in Clinical Bioethics consultations. As well to establish the consulting profile in which family relationships difficult to resolve the problem or ethical conflict: applicants, specialty, records in electronic medical records, patients and family relations. Methods: We analyzed 307 records of Clinical Bioethics ondemand assistance consultations, conducted by the Bioethics Division, Hospital de Clinicas de Porto Alegre from 2010 to 2011. Data were collected from the records of the Bioethics Division and electronic medical records of patients. Were excluded proactive consultancies carried out in regular Clinical Rounds of healthcare, the regular meetings of the Division and the meetings of Clinical Bioethics Committe. For qualitative analysis was used content analysis and classification of seven aspects for family relationships (Nelson and Nelson). The quantitative evaluation was performed by descriptive measures and associations, using SPSS 18.0. Results: In 57% of the 307 records of family relations consultant evaluated the patients involved were predominantly (38%) making it difficult to resolve the problem or ethical conflict. These consultancies, whose families have added difficulties (n = 116), 71% of consultations were generated by requests from physicians. Internal Medicine, Pediatrics and Psychiatry Services demanded 56% of consultants. In 79% of the records was possible to identify patient records associated with it. As for response, 71% of consultations were seen on the same day or the day after your request. The patient characteristics, distribution in relation to gender, was balanced, with a predominance of adult age group and 54% were from Porto Alegre. Family relationships identified as naturally imposed were the most predominant (72%). In the same 116 families were identified the seven aspects of family relationships: Intimacy, Not Replacement, Reasons, Responsibility, Links, Family Plots and Modeling. Conclusion: The understanding of the presence and influence of families, especially when they hinder the resolution of the problem or ethical conflict, identifying the profile of these consultants, as well as reflections on aspects of family relationships, can extend the possibilities to assess cases of Clinical Bioethics and institutional policies that involve the process of decision making in health care services.

Bioethicists have made great strides in identifying and addressing biases that can negatively impact healthcare outcomes. However, the scope of these efforts has rarely included mental healthcare, such as psychotherapy. Discussion of healthcare biases also does not address socio-economic class as adequately as it should. In what follows, I argue that class related biases may be detrimental to the effectiveness of mental health treatment. Unconscious class biases may harm the relationship between a psychologist and patient in ways that are not adequately understood or appreciated. I also examine ways in which class bias may be incorporated into current anti-bias education and training practices. / Urban Bioethics

In this dissertation I argue that properly situating Van Rensselaer Potter's bioethics makes it newly available to those seeking an alternative conceptual framework for global bioethics discourse. Locating Potter in the heretofore unappreciated context of the land-grant college ideology (evinced by those institutions established by the 1862 federal Morrill Act with a charge to democratize higher education and apply knowledge in the best interests of the public) and the Wisconsin Idea (a still–extant Progressive – era policy of applying university research to social legislation) not only illuminates its distinctive features but renders transparent its previously opaque epistemic culture. I outline how American bioethics as it is commonly understood took form at Georgetown University in the early 1970s with a mandate to consider the impact of new medical technologies on society, particularly in relation to reproductive and human fetal tissue research. This work yielded a vision that became known as principlism, the now-dominant form of Western bioethical discourse. I look at the various criticisms of principlism, as well as the inability of its critics to discard the principles framework. I then contrast principlism with the distinctly different understanding of bioethics that was offered in 1970 by Van Rensselaer Potter when he coined the word "bioethics." I discuss how, when Potter first began to speak of bioethics, he envisioned a "bridge to the future, " a union of science and the humanities that would foster cross–disciplinary thinking in anticipation of, and in the hope of averting, a worsening ecological crisis and its resultant negative impact on human health and well–being. The response to threats posed by technology — "dangerous knowledge" — was not to limit knowledge, but to respond with more knowledge, with the kind of contextual and moral vision that only transdisciplinary knowledge could provide. While Potter originally envisioned this work as a specific obligation of scientists, he gradually came to understand it as a social activity, a shift in communal perceptions and obligations. Finally, I suggest that Potter's bioethics has tremendous potential for redeeming bioethics and offers an alternative vision that is truly redemptive.

Ubuntu is a worldview and a way of life shared by most Africans south of Sahara. Basically Ubuntu underlines the often unrecognized role of relatedness and dependence of human individuality to other humans and the cosmos. The importance of relatedness to humanity is summarized by the two maxims of Ubuntu. The first is: a human being is human because of other human beings. The second maxim is an elaboration of the first. It goes; a human being is human because of the otherness of other human beings. John Mbiti combines those two maxims into, "I am because we are, and we are because I am." Ubuntu worldview can provide insights about relationships with communities and the world that contribute to the meaning of Global Bioethics. <br>Ubuntu can be described as involving several distinct yet related components that can be explored in relation to major strands of discourse in contemporary Bioethics. The first component of Ubuntu deals with the tension between individual and universal rights. The second component of Ubuntu deals with concerns about the cosmic and global context of life. The third component of Ubuntu deals with the role of solidarity that unites individuals and communities. Ubuntu has a lot in common with current discourse in bioethics. It can facilitate global bioethics. It can inspire the on-going dialogue about human dignity, human rights and the ethics that surround it. It can inspire and be inspired by global environmental concerns that threaten the biosphere and human life. Ubuntu can critique the formal bioethical principles of autonomy, justice, beneficence and non-maleficence. Above all, Ubuntu can create a basis for dialogue and mutually enlightening discourse between global bioethics and indigenous cultures. Such a dialogue helps make advancements in bioethics relevant to local indigenous cultures, thereby facilitating the acceptability and praxis of global bioethical principles. / McAnulty College and Graduate School of Liberal Arts; / Philosophy / PhD / Dissertation;

Thesis (PhD)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The distinction between treatment and enhancement is often considered to be a morally significant boundary, which, at the very least, marks the limits of our moral obligations. This conviction holds despite the fact that treatment and enhancement are situated along a continuum of interventions that are directed towards the improvement of human functioning. The distinction between these two sorts of interventions is based upon a notion of normative normality, which suggests that we are morally obligated to provide interventions which are directed toward the achievement of normal functioning, but that no obligation exists to improve functioning beyond this point. This dissertation will subject this position to critique by examining the constitution of normal functioning, and by suggesting that this kind of functioning cannot operate as a normative standard which determines the limits of our moral obligations. The moral desirability which we attribute to the achievement of normal functioning is based upon the independent ethical imperative to promote the possibilities for well-being of moral agents. This motivation, however, equally suggests that we will be obligated to provide certain kinds of enhancement interventions which will be likely to promote the welfare interests of moral agents, when these become available. This argument also implies that the development of enhancement technologies will require us to rethink our ethical conception of harmful non-benefits. We currently think of the non-provision of medical treatment and some environmental enhancements, such as education, as harmful to the extent that state intervention is justified to rectify this. We recognise that such non-provision, and the resultant failure to promote the welfare interests of moral agents, where such promotion is possible, harms persons by putting them in a worse position than they could have been in, with regards to their chances of leading a good life. The new technological possibilities offered by the prospect of genetic enhancement mean that we might soon have a better alternative, in terms of our chances of leading a good life, to the level of functioning that we have thus far been able to achieve. This implies that the non-provision of these enhancements would be harmful to the extent that intervention to bring about this provision would be justified. / AFRIKAANSE OPSOMMING: Die onderskeid tussen behandeling (“treatment”) en verbetering (“enhancement”) word dikwels geag 'n skeiding daar te stel wat van morele belang is, in soverre dit ten minste, die perke van ons morele verpligtinge afbaken. Hierdie oortuiging geld ten spyte van die feit dat behandeling en verbetering op „n kontinuum van ingrype wat op die verbetering van menslike funksionering gerig is, geleë is. Die onderskeid tussen hierdie twee tipes ingrype is gebaseer op 'n bepaalde begrip van normatiewe normaliteit, wat suggereer dat ons moreel verplig is om ingrype te voorsien wat daarop gerig is om normale funksionering te bewerkstellig, maar dat geen sodanige verpligting bestaan om funksionering duskant hierdie punt te verbeter nie. Hierdie proefskrif sal laasgenoemde posisie aan kritiek onderwerp deur die manier waarop ons normale funksionering verstaan, te ondersoek, en deur aan die hand te doen dat hierdie tipe funksionering nie as normatiewe standaard wat die perke van ons morele verpligtinge bepaal, kan dien nie. Die morele gewenstheid wat ons toeskryf daaraan om normale funksionering mee te bring, is op die onafhanklike etiese imperatief om die moontlikhede vir welstand van morele agente te bevorder, gebaseer. Hierdie motivering doen egter eweseer aan die hand dat ons verplig sal wees om sekere tipes verbeteringsingrype te verskaf wat waarskynlik die welsynbelange van morele agente sal bevorder, wanneer sulke verbeteringsingrype beskikbaar word. Hierdie argument impliseer ook dat die ontwikkeling van verbeteringstegnologieë van ons sal vereis om ons etiese konsepsie van skadelike nie-voordele opnuut te deurdink. Tans dink ons dat die nie-voorsiening van mediese behandeling, sowel as sommige omgewingsverbeterings soos opvoeding, tot so „n mate skadelik is dat staatsinmenging met die doel om dit reg te stel, geregverdig is. Ons erken dat sulke nie-voorsiening en die gevolglike versuim om die welsynsbelange van morele agente te bevorder, waar sulke bevordering moontlik is, mense skade berokken deur hulle in „n slegter posisie te plaas as waarin hul kon gewees het, ten aansien van hul kanse om 'n goeie lewe te leef. Die nuwe tegnologiese moontlikhede wat die voortuitsig van genetiese verbetering ons bied, beteken dat ons binnekort 'n beter alternatief mag hê vir die vlak van funksionering wat ons tot dusver kon bewerkstellig, ooreenkomstig ons kanse om 'n goeie lewe te leef. Dit impliseer dat die nie-voorsiening van hierdie verbeterings skadelik sal wees tot die mate wat ingrype om hierdie voorsiening teweeg te bring, geregverdig sal wees.

"Mémoire présenté à la Faculté des études supérieures en vue de l'obtention du grade de maîtrise en droit (LL.M.) option Droit, biotechnologies et société" / Le diagnostic et le dépistage prénatals ont été créés pour tenter de diminuer, et parfois même enrayer, les inquiétudes qui habitent les parents, et tout particulièrement la femme, dans la période d'attente qu'est la grossesse. Par contre, la science évolue rapidement. Les nouvelles technologies dans le domaine prénatal s'accumulent sans que nous ayons le temps d'en fixer les limites. Il nous apparaît donc primordial de nous pencher sur la problématique de l'encadrement normatif du diagnostic et du dépistage prénatals, afin de comprendre les dilemmes auxquels sont confrontés les différents acteurs. Notre recherche se concentre sur le dépistage par analyse de sérum maternel, une technique de dépistage prénatal. Or, cette technique présente un faible degré de fiabilité. De nombreuses questions éthiques découlent donc de cette pratique. Dans le cadre de notre travail de recherche, nous analysons les enjeux éthiques qui entourent l'utilisation de ce dépistage, puisque les normes éthiques peuvent exercer une certaine influence sur la pratique médicale. De plus, suite à nos recherches, nous avons pu constater que la pratique du dépistage par analyse de sérum maternel est très différente d'un pays à l'autre, et même, d'une région à l'autre dans un même pays. Cette disparité ne s'observe pas uniquement dans la pratique, mais également au niveau des normes juridiques et professionnelles encadrant cette pratique. De plus, en ce qui a trait à l'application des instruments normatifs, selon le pays dans lequel on se trouve, les cours de justice ne traitent pas de la même façon les actions fondées sur une naissance préjudiciable ainsi que celles fondées sur une vie préjudiciable, qui sont directement reliées au diagnostic et au dépistage prénatals. Il est donc intéressant d'effectuer une comparaison entre la pratique et l'encadrement normatif (juridique, professionnel, jurisprudentiel et éthique) du dépistage par analyse de sérum maternel. Notre travail de recherche a donc pour but de proposer quelques recommandations au sujet de l'attitude à adopter au Québec en regard du dépistage par analyse de sérum maternel, et même du diagnostic prénatal dans son ensemble. / Prenatal diagnosis and screening methods were created in an attempt to decrease, and even to eliminate, the worries of parents, especially those of the mother, during the waiting period of pregnancy. However, science evolves rapidly. New technologies in the prenatal field accumulate without giving us the time to set their boundaries. It therefore seems primordial to consider the issues surrounding the legal framework of prenatal diagnosis and screening methods in order to understand the dilemmas which face the different actors in this field. Our research foc uses on maternaI serum screening, one of the prenatal screening techniques. Indeed, this screening method is not very reliable. Actually, many ethical questions stem from this practice. In our research project, we analyze the ethical issues that emerge from the use of this screening method, since ethical nonns may exert a certain influence on medical practice. Furthennore, according to our findings, we have been able to recognize that maternaI serum screening varies from one country to another, and even from one region to another within the same country. This disparity is not only observed in practice, but it is also seen at the level of legal and professional nonns providing the current framework for this method. In addition, with regards to the application of existing nonnative 1Ools, according to the country considered, the courts of justice do not treat in the same fashion wrongful birth c1aims and wrongfullife c1aims, both unfortunate events directly related to prenatal diagnosis and screening. Therefore, it is interesting to compare maternaI serum screening on the level of what occurs in actual practice versus what is provided by the legal, professional, jurisprudential and ethical nonns in the field. The goal of our research is to propose a few recommendations on the attitude that should be adopted in Quebec concerning maternaI serum screening, and even prenatal diagnosis in general.

In this thesis I have examined Anti-Natalism, specifically arguments by David Benatar, which conclude that human procreation is under all circumstances wrong, and Seana Shiffrin, which concludes that procreation is a “moral hard case.” I provide objections and responses to each argument of my own, as well as those from Saul Smilansky, Rivka Weinberg, and David Wasserman. I also examine the manner in which female unemployment rates (as well as aggregate female and male) unemployment rates in a year between 2005 and 2014 impact fertility rates in the following year (from 2006-2015).