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EN
The article presents the issue of state participation in the financing of couples’ infertility treatment with in vitro fertilization. The author emphasizes that highly interesting topic of clinics recommended for infertility treatment has not been sufficiently developed. This subject is systematically developed in the public discourse, but the society, which still remains divided in the matter of state and municipal government participation in the funding of couples' infertility treatment with in vitro. The author presents the evolution of Ministry’s of Health In Vitro Fertilisation Programmes which came under the governance of the Law and Justice party (PiS) in 2016.
EN
Contemporary medicine offers more and more possibilities as far as procreation is concerned. They are available, first of all, to infertile couples (IVF – In Vitro Fertilization). However, the advanced reproductive technology is also used by people who are biologically capable of having children. These people are ready to resign voluntarily from pregnancy and childbirth difficulties. The surrogate motherhood appears as a phenomenon known already from biblical times but existing nowadays in a different context. At the same time, some issues are emerging – questions concerning social, ethical, moral and legal consequences. This paper presents the issue of surrogate motherhood in the context of social changes, which could lead to a development of such practices as well as the reasons of parents and surrogate mothers. Can this phenomenon be perceived as a service for people who want to fulfill their desires for having children? Would surrogate motherhood become a socially approved practice? What are the ethical, religious and legal norms concerning this phenomenon? The religious norms are connected, first of all, with an attitude of the Catholic Church which recognizes surrogacy as unacceptable and states that “it offends the dignity and the right of a child to be conceived, carried in the womb, delivered to the world and brought up by their own parents”. The ethical norms refer to the biotechnological issues and include matters of creating and implanting human embryos as well as the problem of the surrogate mother – child – biological parents relationship. As far as legal norms are concerned, the case is still open hence Polish law does not take into consideration in vitro fertilization or the admissibility of surrogate motherhood.
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Content available remote ART and Age − Gender Stereotypes in Medical Students’ Views
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EN
It seems interesting to find out how the situation of the Polish ART practice is reflected in the medical students’ opinions. To answer this question we carried out a two-stage research adopting a data-driven methodology based upon the grounded theory, in which we collected a mixture of quantitative and qualitative data. Our study has revealed students’ high acceptance of IVF and most of the additional procedures, except for IVF in the case of women over 40 and postmenopausal ones. The students’ main concerns were to be compatible with what is presented in medical literature and commonly accepted in medical practice, so the core categories they focused on in their argumentation were medical evidence and medical standards. Whereas the students were consistently trying to ground their reasoning on medical knowledge, their opinions reflected not only statements based on hard data, but also some gender stereotypes hidden in medical literature.
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EN
The present article is an attempt to determine the range of protection of the right to human life in the French legislation. Taking into account the indicated problem area, the author draws attention to the fact that this protection relates to each phase of the biological development of man, beginning with the pre-natal stage, through the post-natal period until the end of life. However, in dependence on the degree of man’s development (the embryo, fetus, child, adult) the level of its advancement is different. It needs remembering that the French law protects human life on both the civil and penal planes. Still, depending on the type of norm, the range and character of protection provided to man are different, too. As far as the French civil law is concerned, it is human beings who are guaranteed the primacy by the legislature through prohibition of any attempts on their dignity, and the protection of the individual starts from the moment of their birth. In turn, the criminal law imposes an absolute prohibition of depriving humans of Les remarques sur les limites de la protection de la vie humaine dans la le droit français 37 their lives in an intended manner. It must be stressed that the problem area discussed in the article required making reference to two categories of problems: on the one hand – an essay to qualify the limits of human life as regards temporal aspects and designating the initial and final moments of human existence, on the other one – a concrete reference to questions immanently connected with the sphere of conditions and circumstances of permissibility for individual’s existence or that of cessation of it (abortion, the status of human fetus, artificially aided procreation or euthanasia). In the concluding part of the considerations, it is stated that the question of protection of human life undoubtedly is an extremely complicated issue and raises numerous doubts of the interpretative nature. Indeed, from both the biological and legal perspectives there arise serious difficulties to precisely establish the individual stages of human development, as well as adjusting the law to varying conditions of protection of it. Therefore, in each situation where legal norms do not satisfy the requirements posed to them there opens a field of ethical reflection which relates to interpretation of the limits within which human life proceeds.
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Content available Podmiotowość prawna dziecka nienarodzonego
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EN
Contemporary medicine, ethics and law have been trying to pinpoint the exact moment when a being starts to be a human being and as such acquires his specific rights and duties. It is a moot point and there are numerous controversies concerning this issue, because according to some thinkers a human being possesses the status of being a person from the moment of fertilization, according to others this status is acquired only when the embryo is implanted inside the woman’s womb. The law, both civil and canon, plays an important role in this debate. It can be said that it is the positive law that bestows on an embryo a legal status by determining the attribute which is indispensable for being a human (conditio sine qua non). Meeting this condition is required for a human being to possess legal rights and duties, e.g. the right to be protected by the law from the very moment of conception. Unfortunately, the Polish civil law (and in that it differs from the canon law), although it deals wit h the protection of a new life in the mother’s womb and forbids abortion, does not ascribe a legal status to the embryo in an explicit way and thus permits many malpractices concerning an unborn child (for example abortion in specific circumstances and in vitro fertilization).
EN
This article presents an analysis of the views and opinions of secondary school students in Kalisz and university students in Poznań in regard to in vitro fertilization and its use by infertile couples. The basis for the analysis is sociological research conducted in the years 2007 and 2011 among 456 secondary school students and 426 university students.
EN
Introduction to the practice of modern medical procedures disturbing genetic and epigenetic determinants of human development leading to genetic disorders and/or reduced survival as a result of congenital malformations raises a number of bioethical problems. Due to its genetic and biological basis of its functioning the human being is a human being from the conception. From the point of view of a clinical geneticist, procreation of a new human being is the creation of a new individual genome, that is database on the genetic information obtained from the parents through their reproductive cells and then starting the duplication and imprinting (labelling), and creating opportunities for its reading and modifying in the course of further development (gene expression and its regulation). In the article there are discussed problems arising from health risk, life and dignity of the child and their parents resulting from the use of in vitro fertilization methods.
PL
Wprowadzenie do praktyki medycznej nowoczesnych procedur zaburzających genetyczne i epigenetyczne uwarunkowania rozwoju człowieka, prowadząc do schorzeń rozwojowych i/lub ograniczonej przeżywalności wskutek wad wrodzonych rodzi wiele problemów natury bioetycznej. Ze względu na swoje genetyczne wyposażenie i biologiczne podstawy jego funkcjonowania istota ludzka jest człowiekiem od poczęcia. Z punktu widzenia genetyka klinicznego prokreacja nowej istoty ludzkiej jest utworzeniem nowego indywidualnego genomu, czyli bazy danych w zakresie informacji genetycznej otrzymanej od rodziców poprzez ich komórki rozrodcze, a następnie uruchomieniem jej powielania i znakowania (replikacja i piętnowanie) oraz stworzenie możliwości do jej odczytywania i modyfikacji w trakcie dalszego rozwoju (ekspresja genów i jej regulacja). W artykule zostały omówione problemy zagrożeń zdrowia, życia i godności dziecka, i jego rodziców, wynikających z zastosowania metod pozaustrojowego zapłodnienia in vitro.
EN
The focus of the study was to take a look at the functions of telling personal experience stories on the Estonian internet family discussion forum Perekool (Family School) subforums dedicated to conception, pregnancy, and childbirth. The analysis was based on four groups of stories and their comments: ‘strip catchers’’ stories (stories of women who want to get pregnant), IVF (in vitro fertilization) stories, ‘belly growers’’ stories (stories of pregnant women), and childbirth stories. The aim was to find out which role these stories play from the point of view of the functioning of the internet group, and which are these broader socio-cultural meanings and motives why women share their personal stories with delicate content on the easily accessible internet forum. The following categories of functions of personal experience stories emerged from the research: support and help, information exchange and advice, warning, self-presentation, and entertainment. Sharing personal experience stories on an internet forum can provide support and help for both their writers and readers. The woman who wants to get pregnant, is undergoing in vitro fertilization procedure or is expecting a baby can feel lonely or isolated if she has no close people with similar experiences and understandings of her condition (what is ‘right’ or ‘wrong’, ‘normal’ or ‘abnormal’). Sometimes a woman prefers to conceal her experiences, thoughts, and feelings, because she is afraid of being misunderstood. For example, women’s long-term problems related to getting pregnant and in vitro fertilization seem to be topics that the wider public knows very little about, and that is why women prefer to share their stories and get support and help on the internet forum from those who have similar experiences and thus may understand them better. Both writing and reading the personal experience stories provide psychological support to group members, driven by understanding that only the women who have experienced the same can truly help. The so-called ‘success stories’ play an important role in mutual assistance. A woman can share her success story with the aim of getting in return other women’s stories with a happy ending or the aim may be to offer hope and support to others. Personal experience stories function as information exchange in the sense that they are an important alternative or additional source of information that women get from their relatives, doctors, and midwives. Women may prefer to get information from others’ experiences and stories posted on the internet forum because they have not found a common language with medical staff. For example, women with endometriosis write in their stories that the diagnosis was a shock for them because they did not know anything about it and the doctor gave them very little hope (or not at all) to become a mother. On the other hand, women have found advice and information suggesting they might still get pregnant from other women’s stories. The stories have a kind of informal advisory function because they allow access to the experiencer’s point of view. Both configuring your own experience into a story and reading about others’ experiences help women better understand their condition and become aware of potential different solutions of their problems. The aim of the story writer may also be to initiate a discussion on her own experiences. In this respect, the study revealed that the longer narrative form (a detailed description of the experience, related events and emotions) can provide more specific feedback and advice from group members than a mere question-answer style conversation. A personal experience story can also function as a warning that leads women to stand up for themselves in communication with medical staff and to avoid their own thoughts and activities that they might regret later. In addition to the activities in the physical space, the purpose of writing a story can be to warn against the risks associated with the use of the internet. Personal experience stories work as self-presentation on the internet forum in the sense that they show how women manage their experience. The stories also enable women to show that they belong to a particular group of people with similar interests and experiences. So, there is only one meaningful ‘my story’ per person within the Family School subforums titled Conception, Pregnancy, and Childbirth. The personal experience stories on these forums function as business cards, which allow women to introduce themselves when they join the group and by which other group members identify them later in the discussions even if women participate anonymously (for that purpose anyone can use the pseudonym Cuckoo). However, in spite of accessibility of the discussion forum (the postings are easy to find by a search engine and can be read by all internet users), the women do not write their stories to present themselves and their stories to the general public, but only to peers, i.e., other women with similar experiences. The easily accessible (public) internet forum is perceived as private communication space of a particular interest group because there is an implicit assumption that the forum is used and the conversations there are read only by those who go through a similar life period and who need, based on personal experiences, to participate in the group. A personal experience story can be entertaining for both the writer and the reader. Entertainment as the function of women’s stories emerges in relation to comparing experiences and ‘expecting together’, but also in connection with the fact that sharing the story at the end of the journey of strip catching, in vitro fertilization or pregnancy has become an unwritten rule of the internet group – the woman who has spent time reading other’s stories is expected to share her own story as well. Also, entertainment as a function emerges if, in the passage of time, women share their stories on the forum in response to other ones, when the concrete topic and experience are no longer relevant to them. To what extent and in what form one or another of the functions of the experience stories emerges, depends on the core experiences, interests, problems, and needs of the concrete subgroup.
EN
The article describes functioning of a woman undergoing in vitro fertilization and the influence of this method on relationship between husband and wife. The author seeks the answer to some questions: why do some couples decide on in vitro fertilization? What moral dilemmas do they meet on the way to achieve their goal etc. In order to find the answer of these questions the author drafted the questionnaire form and made it available on portals: abrahamisara.pl, babyboom.pl, kafeteria.pl, gazeta.pl, I am supporting in vitro - facebook and others. The questionnaire survey lasted about one year (2014). It revealed numerous threats to the mother as well as to the child associated with some clinical practices with in vitro fertilization, threatening human rights, the dignity of human person and of marriage.
PL
Celem artykułu jest ukazanie funkcjonowania kobiety w programie in vitro oraz wpływ tej metody na relacje wewnątrzmałżeńskie. Autorka poszukuje odpowiedzi na pytania: czym kierują się osoby decydujące się na procedurę sztucznego zapłodnienia, jakie są moralne dylematy osób podchodzących do programu in vitro itp. W celu znalezienia odpowiedzi autorka sporządziła ankietę i udostępniła ją na portalach: abrahamisara.pl, babyboom.pl, kafeteria.pl, gazeta.pl, popieram in vitro – Facebook i inne. Badania trwały około jednego roku (2014). Ujawniły one liczne zagrożenia zarówno dla matki, jak i dziecka, związane z niektórymi praktykami klinicznymi związanymi z praktyką in vitro, które uwłaczają godności zarówno osoby ludzkiej, jak i małżeństwa.
EN
Church – faithful to the mission commissioned by Christ – take successively the topics that appear throughout the history of mankind, which are the result of scientific development and progress of civilization, and increasing the possibility of interfering with the processes of life – from procreation, and the dying ending. Undoubtedly, the field of interference in human procreation is the one that because of the tremendous progress achieved and the personal good, especially endangered in its activities – requires special vigilance of the Church. Therefore, in this publication is presented clear moral teaching of the Church concerning the abuses in the field of procreation. For the fundamental fraud, which became the subject of moral reflection should include: contraception, morning after pill, sterilization and abortion, in vitro fertilization and cloning. It should be noted that all these issues related to human reproduction right contradict the Christian tradition for centuries, and above all the Church’s thought for contemporary view of marriage, family, sexuality and fertility. Break for inner unity, mutuality and the need for relationships between spouses, but also the relationships between parents and offspring. For this reason, must be evaluated negatively. These phenomena are in fact the opposite nature – sexuality without procreation on the one and procreation without sexuality on the other.
EN
The article primarily concerns the perception of marriage and family life among both young and adult Polish people. We focus on family consciousness or the pro-family ideology, recognized values and pro-family norms. The subjective and conscious dimension of marriage and family life is conditioned by a variety of references in the macro and microstructure. However, marriage and family life as such also affects the attitudes and behavior of people, especially family members. Our study shows that about 25% of young people in Poland approve of the values and norms of Catholic ethics of marriage and family; about 50% take a selective attitude, and about 25% have completely departed from Catholic morality. With regard to the entire Polish society, acceptance of these values and norms stands at about 40%; partial approval and partial disapproval (a selective attitude) – 40%, and total disapproval – 20%. The approval of the pro-family values and norms among practicing Catholics only, would come out to be, at least, 5% greater.
PL
W niniejszym artykule zajmujemy się niemal wyłącznie świadomościowymi aspektami życia małżeńskiego i rodzinnego, czyli tym, jak młodzież i dorośli Polacy postrzegają i oceniają oraz wartościują wybrane elementy życia małżeńskiego i rodzinnego. Większość problemów dotyczących rodziny jako grupy społecznej i instytucji społecznej, struktury rodziny i procesów społecznych w niej zachodzących, związków rodziny z mikrostrukturami, mezostrukturami i makrostrukturami społecznymi, pozostaje poza obszarem naszych analiz socjologicznych. Zajmujemy się świadomością rodzinną czy ideologią prorodzinną, uznawanymi wartościami i normami prorodzinnymi. Subiektywna czy świadomościowa płaszczyzna życia małżeńskiego i rodzinnego jest uwarunkowana wielorako różnorodnymi odniesieniami w makro- i mikrostrukturze, ale i sama oddziałuje na postawy i zachowania ludzi, przede wszystkim członków rodziny. Można by ogólnie szacować, że w środowiskach młodzieżowych w Polsce około 25% badanych aprobuje wartości i normy katolickiej etyki małżeńskiej i rodzinnej, około 50% prezentuje postawy selektywne i około 25% całkowicie odeszło od tej moralności. W odniesieniu do całego społeczeństwa aprobata tych wartości i norm kształtuje się na poziomie około 40%, aprobata częściowa i dezaprobata częściowa (postawy selektywne) – 40% i pełna dezaprobata – 20%. Gdybyśmy chcieli oszacować wyłącznie postawy katolików wobec wartości i norm prorodzinnych, należałoby przyjęte wskaźniki nieco zmienić, w kierunku większej aprobaty tych wartości i norm (wzrost aprobaty przynajmniej o 5%). Wszystkie proponowane oszacowania mają jedynie charakter prawdopodobny a bardziej precyzyjne procedury obliczeń mogłyby wprowadzić nawet znaczące korektury
EN
According to World Health Organization infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. It is estimated that the problem with having children concerns nowadays even 5–6 marriages in the world. Infertility treatment depends on the cause of infertility, but usually it includes diagnose causes of infertility, medical counselling, conservative treatment, surgery and the procedure of medically assisted procreation. Due to its complexity, infertility treatment problem cannot be considered only from the medical point of view. It also needs to be considered in ethical, psychological, religious, social and legal terms. Concerns about lack of infertility treatment law in Poland have been repeatedly raised over the last few years. Finally, after few failed attempts an Infertility Treatment Act has entered into force. Generally speaking, the adoption of the abovementioned act should be assessed positively. However, it is necessary to try to find the answer whether the Infertility Treatment Act complies with applicable ethical standards.
PL
Zgodnie z definicją zaproponowaną przez Światową Organizację Zdrowia niepłodność to choroba, której skutkiem jest niemożność zajścia w ciążę pomimo podejmowania regularnego, przynajmniej rocznego, współżycia płciowego z pominięciem stosowania środków antykoncepcyjnych. Szacuje się, że współcześnie problem z możliwością posiadania dzieci dotyka co 5–6 małżeństwo na świecie. Z uwagi na swoją złożoność, zagadnienie leczenia niepłodności nie może być rozpatrywane jedynie z punktu widzenia stricte medycznego. Konieczne jest dokonanie jego pogłębionej analizy również w aspekcie etycznym, psychologicznym, religijnym, społecznym i prawnym. W Polsce wielokrotnie wskazywano na konieczność wprowadzenia aktu prawnego, który regulowałyby problematykę leczenia niepłodności. Ostatecznie, po licznych nieudanych próbach, w dniu 25 czerwca 2015 r. uchwalono Ustawę o leczeniu niepłodności. Uchwalenie wyżej wskazanej regulacji, a w efekcie usunięcie stanu niepewności prawnej, należy ocenić pozytywnie. Przechodząc jednak do analizy przepisów ustawy o leczeniu niepłodności, należy spróbować odnaleźć odpowiedź na pytanie, czy obowiązująca ustawa spełnia standardy etyczne.
19
Content available Powikłania położnicze wspomaganego rozrodu
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EN
Since the first live birth resulting from in vitro fertilization (IVF), there has been a dramatic rise in the number of infants born as a result of this technology. Assisted reproductive technologies (ART) are now widely used in the treatment of human infertility. It is likely that well over 1 million babies have been born worldwide using ART. The majority of perinatal morbidity after assisted reproductive technology is due to multiple pregnancies. In United States and Europe even 30% of twins are conceived by IVF, intracytoplasmic sperm injection (ICSI), or frozen embryo replacement (FER). ART carries a significantly increased risk of multiple pregnancies, which are associated with a higher rate of prematurity and low birth weights, and carry well‑established risks of morbidity to the child. Many recent studies have suggested also that even singleton pregnancies are at increased risk for preterm birth, low birth weight, congenital anomalies, perinatal mortality and several other pregnancy‑related complications. In addition, it has been shown that the infertility characteristics of the parents may influence the perinatal outcome. Finally, procedural factors related to fertility treatments themselves may confer health risks to ART children. These include the artificial induction of ovulation with the possibility of changes in follicle milieu and oocyte structure, exposure of sperm and embryos to in vitro environments which might change their natural function, freezing and manipulation of oocytes and embryos.
PL
Od czasu, kiedy na świat przyszło pierwsze dziecko urodzone w wyniku zapłodnienia pozaustrojowego, gwałtownie wzrasta liczba dzieci poczętych przy zastosowaniu technik rozrodu wspomaganego. W chwili obecnej są one szeroko stosowane w leczeniu niepłodności. Szacuje się, że na całym świecie w ten sposób urodziło się dotychczas blisko milion noworodków. Główną przyczynę powikłań związanych z rozrodem wspomaganym stanowią ciąże mnogie. W USA i Europie nawet około 30% bliźniąt zostaje poczętych w wyniku zapłodnienia pozaustrojowego, mikroiniekcji plemnika do komórki jajowej lub transferu zarodka mrożonego. Metody te wiążą się niestety ze zwiększonym ryzykiem uzyskania ciąż mnogich, a co za tym idzie – ze wzrostem ryzyka wcześniactwa, niskiej masy urodzeniowej, a także śmiertelności okołoporodowej dzieci. Niektóre publikowane ostatnio badania wskazują również, że także ciąże pojedyncze będące wynikiem zastosowania technik wspomaganego rozrodu częściej powikłane są porodem przedwczesnym, niską masą urodzeniową noworodka, wadami wrodzonymi u dzieci, zwiększoną śmiertelnością okołoporodową noworodków oraz innymi ciężkimi powikłaniami położniczymi. Ponadto wykazano, że same czynniki decydujące o niepłodności u rodziców mogą wpływać na występowanie powikłań w czasie ciąży i porodu. W końcu także sama procedura związana z zapłodnieniem pozaustrojowym niesie ryzyko powikłań u poczętych w ten sposób dzieci. Należy tu wspomnieć o sztucznej indukcji owulacji, która może wpłynąć na środowisko wewnątrz pęcherzyków oraz struktury oocytu, ekspozycji zarówno nasienia, jak i embrionów na czynniki zewnętrzne, co może prowadzić do zaburzenia ich naturalnej funkcji, jak również zamrażaniu i manipulowaniu przy oocytach i embrionach, między innymi w czasie diagnostyki preimplantacyjnej.
EN
During the past decade the need for Artificial Reproductive Techniques in felids has greatly increased. Mostly, this is a result of growing expectations that these techniques may be applied in conservation biology and thereby contribute to saving wild felids from extinction. In this article we describe three most common methods of obtaining embryos in vitro in the domestic cat and its wild relatives: classic in vitro fertilisation, in vitro fertilisation by intracytoplasmic sperm injection and somatic cell nuclear transfer. Each of the methods provides a cleavage rate of around 50% and approx. 20% of embryos develop to the blastocyst stage. After the transfer of embryos produced by these methods, scientists obtained living offspring of the domestic cat, as well as several wild cats: the tiger, serval, fishing cat, caracal, ocelot, wild cat, sand cat, black-footed cat and the oncilla. These successes, in spite of the low efficiency of the discussed methods, are promising and suggest that biotechniques of reproduction will be valuable tools in the protection of wild species. Somatic cell nuclear transfer will allow to sustain the narrow gene pool in the critically endangered felids. For these reasons it is necessary to conduct further research on the optimization of artificial reproduction techniques in cats.
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