Jinekolojik Diğer Uygulamalarda Etik
Özet
Bu bölümde, modern tıp ve biyoteknolojinin kadın sağlığında sunduğu önemli uygulamaların etik boyutları tartışılmaktadır. Meme kanserinde genetik tarama, menopozda hormon replasman tedavisi (HRT) ve uterus transplantasyonu örnekleri üzerinden, bu müdahalelerin bireysel özerklik, bilgilendirilmiş onam, mahremiyet, ayrımcılık ve adalet ilkeleri çerçevesinde yarattığı etik ikilemler ele alınmıştır. Genetik testlerin psikolojik etkileri, bilgiye erişim ve paylaşım hakkı, sigorta ve istihdamda ayrımcılık riski gibi konular, bireylerin mahremiyet ve karar verme özgürlüğünü doğrudan etkilemektedir. Menopozda HRT kullanımı, kadınların bilgilendirilmiş seçim yapabilme hakkını güçlendirmeyi ve tıbbi karar süreçlerinde adil temsilin sağlanmasını gerektirmektedir. Uterus transplantasyonu ise üreme hakları bağlamında yenilikçi bir seçenek olarak umut vadederken, alıcı, verici ve doğacak çocuk için risk-fayda dengesi, uygunluk kriterleri ve toplumsal etkileriyle karmaşık etik soruları gündeme getirmektedir.
Referanslar
Surbone A. Ethical implications of genetic testing for breast cancer susceptibility. Critical Reviews in Oncology/Hematology; 2001; 40:149–157.
Calzada Mendoza CC, Robledo LA, Martínez GL, Jiménez Zamarripa CA, Hernández Caballero ME. Ethical Considerations in Research and Medical Careof Menopause. Reflections on Bioethics. 2017. DOI: 10.5772/intechopen.74666.
Murtagha MJ, Hepworth J. Feminist ethics and menopause: autonomy and decision-making in primary medical care. Social Science & Medicine; 2003; 56:1643–1652
Koplin JJ, Kendal E. Ethical issues in uterine transplantation. Korean J Transplant. 2020 Jun 30;34(2):78-83. doi: 10.4285/kjt.2020.34.2.78. PMID: 35769346; PMCID: PMC9188934.
T.C. Sağlık Bakanlığı Sağlık Hizmetleri Genel Müdürlüğü Araştırma, Geliştirme ve Sağlık Teknolojisi Değerlendirme Dairesi Başkanlığı Meme Kanseri Korunma, Tarama, Tanı, Tedavi ve İzlem Klinik Rehberi (Versiyon 1.0) Ankara, 2020. T.C. Sağlık Bakanlığı Yayın Numarası: 1170 ISBN: 978-975-590-771-0. (08/05/2023 tarihinde https://shgm.saglik.gov.tr/TR-67115/meme-kanseri-korunma-tarama-tani-tedavi-ve-izlem-klinik-rehberi-yayinlanmistir.html adresinden ulaşılmıştır).
International Agency for Research on Cancer. Global Cancer Oservatory. Breast Cancer. (08/05/2023 tarihinde https://gco.iarc.fr/today/data/factsheets/cancers/20-Breast-fact-sheet.pdf adresinden ulaşılmıştır).
The American Society of Clinical Oncology. Statement of the American Society of Clinical Oncology: Genetic Testing for Cancer Susceptibility. J Clin Oncol; 1996; 14:1730–1736.
Rhodes R. Genetic links, family ties, and social bonds: rights and responsibilities in the face of genetic knowledge. J Med Phil; 1988; 23:10–30.
T Holtzman NA. Are we ready to screen for inherited susceptibility to cancer? Oncology; 1996; 10:57–64.
Reilly PR. Panel Comment: The impact of the genetic privacy act on medicine. J Law Med Ethics; 1995; 23:378–81.
The American Society of Human Genetics Board of Directors and The American College of Medical Genetics Board of Directors. Points to consider: Ethical, legal and psychosocial implications of genetic testing in children and adolescents. Am J Hum Genet; 1995; 57:1233–1241.
Lenoir N. UNESCO, genetics and human rights. Kennedy Inst Ethics J; 1997; 7:31–42.
Gostin LO. Genetic Privacy. J Law Med Ethics; 1995; 23:320–30.
Hoffman D, Wulfsberg EA. Testing children for genetic predispositions: is it in their best interest? J Law Med Ethics; 1995; 23:331–44.
Lancaster JM, Wiseman RW, Berchuk A. An inevitable dilemma: prenatal testing for mutations in the brca1 breastovarian cancer suceptibility gene. Obs Gyn; 1996; 87:306–9.
Baber RJ, Panay N, Fenton A. Collaborative Group. International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health. IMS Climacteric; 2016; 19:109-50.
Vigneswaran K, Hamoda H. Hormone replacement therapy–Current recommendations. Best Practice & Research Clinical Obstetrics & Gynaecology; 2022; 81:8-21.
Skafar DF, Xu R, Morales J, et al. Female sex hormones and cardiovascular disease in women. JCEM; 1997; 82:3913-3916. doi: 10.1210/jcem.82.12.4443
Lacey S. Reproductive Ethics: Ethical Issues and theMenopause. International Encyclopedia of Public Health; 2017; https://doi.org/10.1016/B978-0-12-803678-5.00376-3.
Grady D. Medical first: a transplant of a uterus. N Y Times Web 2002; A1, A11.
Brännström M, Johannesson L, Bokström H, Kvarnström N, Mölne J, Dahm-Kähler P, et al. Livebirth after uterus transplantation. Lancet; 2015; 385:607-16.
Richards, E. G., Farrell, R. M., Ricci, S., Perni, U., Quintini, C., Tzakis, A., & Falcone, T. (2021). Uterus transplantation: state of the art in 2021. Journal of Assisted Reproduction and Genetics, 38(9), 2251-2259.
Jones BP, Saso S, Bracewell-Milnes T, Thum MY, Nicopoullos J, Diaz-Garcia C, et al. Human uterine transplantation: a review of outcomes from the first 45 cases. BJOG; 2019; 126:1310-9.
O’Donovan L, Williams NJ, Wilkinson S. Ethical and policy issues raised by uterus transplants. Br Med Bull; 2019; 131:19-28.
Hammond-Browning N. UK criteria for uterus transplantation: a review. BJOG; 2019; 126:1320-6.
Testa G, Koon EC, Johannesson L. Living donor uterus transplant and surrogacy: ethical analysis according to the principle of equipoise. Am J Transplant 2017;17: 912-6.
Referanslar
Surbone A. Ethical implications of genetic testing for breast cancer susceptibility. Critical Reviews in Oncology/Hematology; 2001; 40:149–157.
Calzada Mendoza CC, Robledo LA, Martínez GL, Jiménez Zamarripa CA, Hernández Caballero ME. Ethical Considerations in Research and Medical Careof Menopause. Reflections on Bioethics. 2017. DOI: 10.5772/intechopen.74666.
Murtagha MJ, Hepworth J. Feminist ethics and menopause: autonomy and decision-making in primary medical care. Social Science & Medicine; 2003; 56:1643–1652
Koplin JJ, Kendal E. Ethical issues in uterine transplantation. Korean J Transplant. 2020 Jun 30;34(2):78-83. doi: 10.4285/kjt.2020.34.2.78. PMID: 35769346; PMCID: PMC9188934.
T.C. Sağlık Bakanlığı Sağlık Hizmetleri Genel Müdürlüğü Araştırma, Geliştirme ve Sağlık Teknolojisi Değerlendirme Dairesi Başkanlığı Meme Kanseri Korunma, Tarama, Tanı, Tedavi ve İzlem Klinik Rehberi (Versiyon 1.0) Ankara, 2020. T.C. Sağlık Bakanlığı Yayın Numarası: 1170 ISBN: 978-975-590-771-0. (08/05/2023 tarihinde https://shgm.saglik.gov.tr/TR-67115/meme-kanseri-korunma-tarama-tani-tedavi-ve-izlem-klinik-rehberi-yayinlanmistir.html adresinden ulaşılmıştır).
International Agency for Research on Cancer. Global Cancer Oservatory. Breast Cancer. (08/05/2023 tarihinde https://gco.iarc.fr/today/data/factsheets/cancers/20-Breast-fact-sheet.pdf adresinden ulaşılmıştır).
The American Society of Clinical Oncology. Statement of the American Society of Clinical Oncology: Genetic Testing for Cancer Susceptibility. J Clin Oncol; 1996; 14:1730–1736.
Rhodes R. Genetic links, family ties, and social bonds: rights and responsibilities in the face of genetic knowledge. J Med Phil; 1988; 23:10–30.
T Holtzman NA. Are we ready to screen for inherited susceptibility to cancer? Oncology; 1996; 10:57–64.
Reilly PR. Panel Comment: The impact of the genetic privacy act on medicine. J Law Med Ethics; 1995; 23:378–81.
The American Society of Human Genetics Board of Directors and The American College of Medical Genetics Board of Directors. Points to consider: Ethical, legal and psychosocial implications of genetic testing in children and adolescents. Am J Hum Genet; 1995; 57:1233–1241.
Lenoir N. UNESCO, genetics and human rights. Kennedy Inst Ethics J; 1997; 7:31–42.
Gostin LO. Genetic Privacy. J Law Med Ethics; 1995; 23:320–30.
Hoffman D, Wulfsberg EA. Testing children for genetic predispositions: is it in their best interest? J Law Med Ethics; 1995; 23:331–44.
Lancaster JM, Wiseman RW, Berchuk A. An inevitable dilemma: prenatal testing for mutations in the brca1 breastovarian cancer suceptibility gene. Obs Gyn; 1996; 87:306–9.
Baber RJ, Panay N, Fenton A. Collaborative Group. International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health. IMS Climacteric; 2016; 19:109-50.
Vigneswaran K, Hamoda H. Hormone replacement therapy–Current recommendations. Best Practice & Research Clinical Obstetrics & Gynaecology; 2022; 81:8-21.
Skafar DF, Xu R, Morales J, et al. Female sex hormones and cardiovascular disease in women. JCEM; 1997; 82:3913-3916. doi: 10.1210/jcem.82.12.4443
Lacey S. Reproductive Ethics: Ethical Issues and theMenopause. International Encyclopedia of Public Health; 2017; https://doi.org/10.1016/B978-0-12-803678-5.00376-3.
Grady D. Medical first: a transplant of a uterus. N Y Times Web 2002; A1, A11.
Brännström M, Johannesson L, Bokström H, Kvarnström N, Mölne J, Dahm-Kähler P, et al. Livebirth after uterus transplantation. Lancet; 2015; 385:607-16.
Richards, E. G., Farrell, R. M., Ricci, S., Perni, U., Quintini, C., Tzakis, A., & Falcone, T. (2021). Uterus transplantation: state of the art in 2021. Journal of Assisted Reproduction and Genetics, 38(9), 2251-2259.
Jones BP, Saso S, Bracewell-Milnes T, Thum MY, Nicopoullos J, Diaz-Garcia C, et al. Human uterine transplantation: a review of outcomes from the first 45 cases. BJOG; 2019; 126:1310-9.
O’Donovan L, Williams NJ, Wilkinson S. Ethical and policy issues raised by uterus transplants. Br Med Bull; 2019; 131:19-28.
Hammond-Browning N. UK criteria for uterus transplantation: a review. BJOG; 2019; 126:1320-6.
Testa G, Koon EC, Johannesson L. Living donor uterus transplant and surrogacy: ethical analysis according to the principle of equipoise. Am J Transplant 2017;17: 912-6.
