Conception in The 21st Century Discussion

Choice two of the following ” What do you think ” statements and write one page of each of them.

What Do You Think?Conception in the 21^st century

More than 30 years ago, Louise Brown captured the world’s attention as the first testtube baby—conceived in a petri dish instead of in her mother’s body. Today, assisted reproductive technology is no longer experimental; it is used more than 160,000 times annually with American women, producing more than 60,000 babies (Centers for Disease Control and Prevention, 2013). Many new techniques are available to couples who cannot conceive a child through sexual intercourse. The best-known technique, in vitro fertilization, involves mixing sperm and egg in a petri dish and then placing several fertilized eggs in the mother’s uterus, with the hope that they become implanted in the uterine wall. Other methods include injecting many sperm directly into the fallopian tubes or a single sperm directly into an egg.

means that a baby could have as many as five “parents”: the man and woman who provided the sperm and egg; the surrogate mother who carried the baby; and the mother and father who rear the baby.

New reproductive techniques offer hope for couples who have long wanted a child but have been unable to conceive, and studies of the first generation of children conceived via these techniques indicates that their social and emotional development is normal (Golombok, 2013). But there are difficulties as well. Only about one third of attempts at in vitro fertilization succeed. What’s

The sperm and egg usually come from the prospective parents, but sometimes they are provided by donors. Typically, the fertilized eggs are placed in the uterus of the prospective mother, but

sometimes they are placed in the uterus of a surrogate mother who carries the baby to term. This

more, when a woman becomes pregnant, she is more likely to have twins or triplets because multiple eggs are transferred to increase the odds that at least one fertilized egg will implant in the mother’s uterus. (An extreme example of this is “Octomom,” a woman who had octuplets following in vitro fertilization.) She is also at greater risk for giving birth to a baby with low birth weight or birth defects. Finally, the procedure is expensive—the average cost in the United States of a single cycle of treatment is between $10,000 and $15,000—and often is not covered by health insurance.

These problems emphasize that although technology has increased the alternatives for infertile couples, pregnancy on demand is still in the realm of science fiction. At the same time, the new technologies have led to much controversy because of complex ethical issues associated with their use. One concerns the prospective parents’ right to select particular egg and sperm cells; another involves who should be able to use this technology.

Pick your egg and sperm cells from a catalog? Until recently, prospective parents have known nothing about egg and sperm donors. Today, however, they are sometimes able to select egg and sperm based on physical and psychological characteristics of the donors, including appearance and race. Some claim that such prospective parents have a right to be fully informed about the person who provides the genetic material for their baby. Others argue that this amounts to eugenics, which is the effort to improve the human species by allowing only certain people to mate and pass along their genes.

Available to all? Most couples who use in vitro fertilization are in their thirties and forties, but many older women have begun to use the technology. Some of these women cannot conceive naturally because they have gone through menopause and no longer ovulate. Some argue that it is unfair for a child to have parents who may not live until the child reaches adulthood. Others point out that people are living longer and that middle-aged (or older) adults make better parents. (We discuss this issue in more depth in Chapter 13.)

What do you think? Should prospective parents be allowed to browse a catalog with photos and biographies of prospective donors? Should new reproductive technologies be available to all, regardless of age?

What Do You Think?When juveniles commit serious crimes should they be tried as adults?

Traditionally, when adolescents under 18 commit crimes, the case is handled in the juvenile justice system. Although procedures vary from state to state, most adolescents who are arrested do not go to court; instead, law enforcement and legal authorities have considerable discretionary power. They may, for example, release arrested adolescents into the custody of their parents. However, when adolescents commit serious or violent crimes, there will be a hearing with a judge. This hearing is closed to the press and public; no jury is involved. Instead, the judge receives reports from police, probation officers, school officials, medical authorities, and other interested parties. Adolescents judged guilty can be placed on probation at home, in foster care outside the home, or in a facility for youth offenders.

Because juveniles are committing more serious crimes, many law enforcement and legal authorities believe that juveniles should be tried as adults. Advocates of this position argue for lowering the minimum age for mandatory transfer of a case to adult courts, increasing the range of offenses that must be tried in adult court, and giving prosecutors more authority to file cases with juveniles in adult criminal court. Critics argue that treating juvenile offenders as adults ignores the fact that juveniles are less able than adults to understand the nature and consequences of committing a crime. Also, they argue, punishments appropriate for adults are inappropriate for juveniles (Steinberg et al., 2009).

What do you think? Should we lower the age at which juveniles are tried as adults? Based on the theories of development we discussed, what guidelines would you propose in deciding when a juvenile should be tried as an adult?

What Do You Think? Does marriage education work?

The Healthy Marriage Initiative really focused a great deal of attention on ways to lower the divorce rate (Fincham & Beach, 2010). One approach endorsed by many groups, called marriage education, is based on the idea that the more couples are prepared for marriage, the better the relationship will survive over the long run. More than 40 states have initiated some type of education program. Do they work?

Most education programs focus on communication between the couple; the programs provide general advice, not specific ways to deal with a couple’s issues. Because only a minority of couples currently attend a marriage education program, there is plenty of room for improvement. Several religious denominations have their own version of marriage education programs; the Catholic’s Pre-Cana program is one example.

There are numerous challenges to more extensive community-based marriage education programs. For example, in some cases, the education programs were originally developed to address poverty (Administration for Children and Families, 2010). Many couples cohabit and are less likely to attend marriage education programs even though there is little evidence that cohabitation improves communication skills between the couple (Fincham & Beach, 2010). As a result, versions of marriage education programs are being adapted for younger adults (who, if they marry while young, have a much higher risk for divorce) and for single adults (to teach them about communication skills). In addition, programs timed at key transition points (e.g., engagement) have also been developed (Halford, Markman, & Stanley, 2008).

Rather than intervene with couples before they marry, some programs target already-married couples (O’Halloran et al., 2013). One of the best known of these programs is Worldwide Marriage Encounter.

Research to date shows that these skills-based education programs have modest but consistently positive effects on marital quality and communication (Cowan, Cowan, & Knox, 2010; O’Halloran et al., 2013). Perhaps not surprisingly, couples who report more problems at the beginning of the program appear to benefit most.

These positive outcomes are resulting in a broadening of the approaches used by marriage educators to topics beyond communication. How these programs develop and whether more couples will participate remain to be seen. What does appear to be the case is that if couples agree to participate in a marriage education program, they may lower their risk for problems later on.

What do you think? Would you be willing to participate in a marriage education program?

What Do You Think? Do women lean out when they should lean in?

Sheryl Sandberg is unquestionably successful. She has held some of the most important, powerful positions in some of the most recognizable technology companies in the world. When she published her book Lean In: Women, Work, and the Will to Lead in 2013, she set off a fierce debate. Sandberg claimed that there is discrimination against women in the corporate word. But she also argued that an important reason women do not rise to the top more often is due to their unintentional behavior that holds them back. She claimed that women do not speak up enough, need to abandon the myth of “having it all,” must set boundaries, need to get a mentor, and must not “check out of work” when thinking about starting a family.

The national debate around these topics raised many issues: Sandberg’s ability to afford to pay for support may make her points irrelevant for women who do not have those resources; her husband’s ability and willingness to share in child rearing and household chores may make her arguments irrelevant for single parents; she was “blaming the victim”; no one ever puts men in these situations of having to choose; and so on.

Does Ms. Sandberg have a valid point to make? Do men and women differ in how they approach careers? Are the differences she notes inherent in men and women, or are they learned? What support systems that are currently missing need to be put in place? What do you think?

What Do You Think? How long would you want to live?

We have considered evidence that average longevity has increased significantly over the past century. This means that there have never been as many older adults alive at one time than there are right now, and this will only increase during the next several decades at least.

Getting older brings with it many positives (in terms of experience, well-being, and other things people enjoy in life) and negatives (especially biological and physical changes, as we will see).

This raises an important question for current generations: How long do you want to live? What, for you, would be the optimal length of life? For some people, the optimal length of life is the number of years they can continue to live independently and well. For others, it’s as long as their life has meaning.

What is it for you? What are the things that help you define your answer? What do you think?

What Do You Think? Reforming Social Security and Medicare

Few political issues have been around as long and are as politically sensitive as those that concern making Social Security and Medicare fiscally sound for the long term. The basic issues have been well known for decades: The present method for raising and distributing revenues in Social Security and Medicare are not sustainable (Social Security and Medicare Boards of Trustees, 2013). Because Social Security and Medicare are based on current workers paying a tax to support current retirees, the looming funding problems depend critically on the worker-to- retiree ratio. This declining ratio places an increasing financial burden on workers to provide the level of benefits to retirees that people have come to expect. Because of this declining ratio, unless major structural changes are made, the Social Security and Medicare systems are headed toward bankruptcy in the foreseeable future, requiring significant reductions in benefits to match expenditures with revenues (Social Security and Medicare Board of Trustees, 2013). So it’s no wonder that young and middle-aged adults have little faith that Social Security or Medicare will be there for them.

Potential solutions to these problems differ. Because Social Security is essentially an income assurance program, there appear to be more options with it. Among the possibilities proposed over the years are:

None of these proposals for Social Security has universal support. Many proposed solutions would significantly disadvantage certain people—especially minorities and older widows—who depend almost entirely on Social Security for their retirement income (Polivka, 2010). Nevertheless, a range of options continues to be discussed.

In contrast, fixing Medicare is more difficult (Davis, 2013). As a health care entitlement program, Medicare must pay for all medically necessary covered benefits for enrollees; except for constraints placed on the program by the health insurance financing mechanism, there are no limits on overall Medicare spending. That leaves the only viable approaches based on (1) further restructuring of the health care system to manage costs better, (2) restructuring of the funding mechanisms including both the Medicare taxes on wages and the premiums and co-pays, or (3) some combination of both.

Solving the funding problems facing Social Security and Medicare will become increasingly important in the next few years. What do you think should be done to stabilize them?

What Do You Think? The Marlise Munoz case

On November 26, 2013, Erick Muñoz, a firefighter in a town near Dallas, came home to find his wife, 33-year-old Marlise, lying on the kitchen floor after experiencing a blood clot in her lungs. She was rushed to John Peter Hospital in Fort Worth, where she arrived alive but not breathing. Within two days, she was declared brain dead. She had made it clear that she did not wish to be left on life support; so her husband and parents informed the physicians in the intensive care unit of their desire to act on those views and asked the physicians to disconnect her from the machine. The physicians refused. Why? Marlise was 14 weeks pregnant, and the physicians believed that a Texas law prohibiting the removal of life support from a pregnant patient trumped the patient’s and family’s clear wishes.

What followed was a legal battle pitting an individual’s and her family’s wishes not to have life prolonged by machine in the case of brain death and the belief that Texas law makes those desires irrelevant in certain cases, essentially requiring that such patients be kept alive on machines. At the core of the debate was the law, initially passed in 1989 and amended in 1999, that states that a person may not withdraw or withhold “life-sustaining treatment” from a pregnant patient. People agreed that the law was aimed at situations in which the pregnant woman was in a coma or persistent vegetative state and “alive” under the laws pertaining to the definition of death. At issue was whether the law also applied to women who were declared brain dead. The hospital decided that it did; Marlise’s family argued that it did not.

Laws such as the one in Texas are common; at least 31 states have laws restricting the ability of physicians to terminate life support for terminally ill pregnant women, irrespective of what those women or their families want. The Texas law requires that life support be maintained no matter how far into the pregnancy the woman is.

Marlise’s case raised several issues for medical ethicists. Many pointed out that if she is brain dead, then she cannot be a patient, and physicians cannot be compelled to treat a deceased person. Others pointed out that because Marlise was dead and the fetus had not reached the point of being viable outside the womb, then there was no hope for the fetus. Still others argued that even if the chances for the fetus to survive to viability were remote, the fetus’s rights to that chance supersede the dead mother’s and her family’s.

On January 24, 2014, Texas state judge R. H. Wallace, Jr., ruled that Marlise, by then 22 weeks pregnant, could be disconnected from life support. The judge agreed with the family’s argument that the hospital had erred in its application of the Texas law. Medical records also indicated that the fetus was “distinctly abnormal” and suffered from hydrocephalus (an accumulation of fluid in the brain) as well as a likely cardiac problem. Because the hospital decided not to appeal the ruling, Marlise was taken off the machine on January 26.

Marlise’s case raises numerous issues about the rights of individual patients, their families, and the unborn. Whose rights are more important? What happens if there is a conflict? Can a state overrule end-of-life decisions that reflect deep personal and religious convictions? How do medical personnel respond if they are required to keep all pregnant women on life support? Are there public obligations to cover the medical expenses in such cases?

What do you think? Should Marlise Muñoz have been removed from life support?