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BACKGROUND: Past studies emphasized the possible cultural influence on attitudes regarding reprogenetics and reproductive risks among medical students who are taken to be "future physicians." These studies were crafted in order to enhance the knowledge and expand the boundaries of cultural competence. Yet such studies were focused on MS from relatively marginalized cultures, namely either from non-Western developing countries or minority groups in developed countries. The current study sheds light on possible cultural influences of the dominant culture on medical students in two developed countries, potentially with different dominant cultures regarding reprogenetics and reproductive risks: Israel and Croatia. METHODS: Quantitative-statistical analyses were employed, based on anonymous questionnaires completed by 150 first year medical students in Israel and Croatia. The questionnaires pertained to the knowledge and attitudes regarding genetics, reproduction and reproductive risks. These questionnaires were completed before the students were engaged in learning about these topics as part of the curriculum in their medical school. RESULTS: Substantial differences were revealed between the two groups of medical students. Israeli medical students were less tolerant regarding reproductive risks and more knowledgeable about genetics and reproductive risks than Croatian medical students. For example, while nearly all Israeli medical students (96%) disagreed with the idea that "Screening for reproductive risks in prospective parents is wrong," less than 40% of their Croatian counterparts shared a similar stance. Similarly, all (100%) Israeli medical students correctly observed that "A carrier of a recessive genetic disease actually has the disease" was wrong, as opposed to only 82% of Croatian students. CONCLUSIONS: By linking applicable theoretical literature to these findings, we suggest that they may reflect the hidden influence of the dominant culture in each country, disguised as part of the "culture of medicine." Acknowledging and learning about such influence of the dominant culture, may be an important addition to the training of medical students in cultural competence, and specifically their cultural awareness. Such an acknowledgement may also pave the road to drawing the attention of existing physicians regarding a less known yet an important aspect of their cultural competence, insofar as the cultural awareness component is concerned.

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A recent article on the front page of The Independent (September 18, 2015) reported that the genetic 'manipulation' of IVF embryos is to start in Britain, using a new revolutionary gene-editing technique, called Crispr/Cas9. About three weeks later (Saturday 10, October 2015), on the front page of the same newspaper, it was reported that the National Health Service (NHS) faces a one billion pound deficit only 3 months into the new year. The hidden connection between these reports is that gene editing could be used to solve issues related to health care allocation. Improving the health of future generations might coincide with public health goals; it might improve the health of individuals and communities, and, if successful, might be seen as a public good. However, enhancing future generations will require In Vitro Fertilisation and Pre-implantation Genetic Diagnosis. Remarkably, the necessary involvement of women in an enhancing scenario has not been discussed by its proponents. The present discourse on moral obligations of future generations, although not referring to women, seems to imply that women might be required, morally, if not legally, to reproduce with IVF. Enhancing future generations will be gendered, unless the artificial womb is developed. These are challenging issues that require a wider perspective, of both women and men. Despite the lack of a unified feminist conclusion in the discussions about the merits and risks of human genome modification, there is an urgent need to clarify the role of women in this scenario.

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The prevalence of autism has increased dramatically. The objectives of this study were to explore attitudes toward prenatal diagnosis to detect autism prenatally and avoid having an affected child and to understand social acceptability of these disorders among students of allied health professions. In this study, college students of nursing and health systems management answered a structured self-report questionnaire (n = 305). The first part addressed the respondent's personal data. The second part targeted the respondent's attitudes toward prenatal diagnosis of non-life-threatening disorders, including autism spectrum disorders. We found that almost two thirds of the students responded that they would not proceed with a pregnancy if the child were diagnosed with autism, and more than half thought that they would not continue with a pregnancy if the fetus were diagnosed with Asperger's. Age, level of religiosity, and years of education were influential. This study is limited in scope; however, the positive attitude of the students toward prenatal diagnosis to avoid having an affected child might also reflect a negative view of autism spectrum disorders in future health care professionals. Further research of attitudes and the social acceptability of autism spectrum disorders, particularly among health care professionals, is required.

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The present study investigated a possible relationship between the attitudes toward genetic technologies and the understanding of genetics, reproduction, and reproductive risk among Israeli Arabs and Israeli Jews. The study included 203 respondents, who answered a structured self-report questionnaire. They were recruited using a snowball method, which increased the participation of Israeli Arabs in the sample, although the sample was not representative of the Israeli population as a whole (there were more Arabs and fewer men). The respondents in this study expressed a positive attitude toward genetic technologies, but were less in favor of using genetic tools for non-medical purposes. Respondents of both groups were not knowledgeable of genetics; however, they scored higher on the items related to reproductive risk, which suggests that some awareness about genetic risk exists in both sectors of the Israeli population. Nevertheless, Israeli Arabs were less positive than Israeli Jews regarding the application of genetic tools. Moreover, although an understanding of genetics correlated positively with the attitude among Arabs, it did not affect the attitude of Jews, who remained very positive, regardless of their level of understanding. This result suggests that other social and cultural factors, besides understanding, might be at work among these two major ethnic sectors. Further studies that integrate educational, social, and cultural aspects among ethnic sectors of the population are required to improve health services and genetic counselling in Israel and in other countries.

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OBJECTIVE: To analyze whether the results and effectiveness of the open-ended treatment with IVF in Israel justifies the policy of limitless nondonor IVF rounds. DESIGN: The research sample included 535 patients. The files of these patients were reviewed; data were extracted into a questionnaire, transferred into digital files, and analyzed with SPSS. SETTING: IVF clinics. PATIENT(S): Two hundred ten women who began IVF treatment in 2000 and 325 women who were in IVF treatment during 2010. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Retrospective analysis of the success rates of live births resulting from cycles with IVF in women who started treatment in 2000, retrospective analysis of IVF results during 2010, and number of cycles in women who were in IVF treatment during 2010. RESULT(S): In the 2000 cohort, the rate of success with IVF was 54%. The success rate fell as the number of unsuccessful cycles and duration of infertility increased; age at the beginning of the treatment was influential. A similar pattern appeared in the group that was in treatment during 2010. The rate of success in the group that was in IVF treatment during 2010 was 16.6%; of the women in this group (2010, ongoing), 25% had already undergone more than five cycles and 12% of the women had already undergone more than seven cycles. CONCLUSION(S): Although limited in scope, this study suggests that the policy of limitless nondonor IVF-ET cycles in Israel should be further examined and assessed.

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The Israeli health care system is looked upon by some people as one of the most advanced health care systems in the world in terms of access, quality, costs and coverage. The Israel health care system has four key components: (1) universal coverage; (2) 'cradle to grave' coverage; (3) coverage of both basic services and catastrophic care; and (4) coverage of medications. Patients pay a (relatively) small copayment to see specialists and to purchase medication; and, primary care is free. However, during 2011 the Israeli Medical Association (IMA) spent 5 months on a strike, justifying it as trying to 'save' the Israeli public health. This paper describes some aspects of the Israeli Health Care System, the criteria for setting priorities for the expenditures on health care and values underlying these criteria. The paper observes that the new agreement between the IMA and the government has given timely priority to problematic areas of specialization (in which there is an acute shortage of physicians) and to hospitals in the periphery of the country. Yet weak points in the health system in Israel remain. Particularly, the extent to which national health care expenditures are being financed privately--which is rising--and the parallel decline in the role of government financing.

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The Israeli public health insurance system covers an (almost) unlimited number of IVF cycles. In a global context, this is a policy which is looked upon as a northern star. However, many women may continue IVF treatment when the probability of a successful pregnancy is 'zero'. This paper argues that the implication of a policy of unlimited rounds of IVF from the perspective of the 'culture of perseverance' that develops in IVF clinics has not yet been fully assessed. A systematic long term assessment of the health and welfare of women after IVF in Israel--especially after prolonged treatment with IVF--is necessary. In a global context, an evidence-based policy on ART may improve both the allocation of resources and the duty of care, not only in Israel, but also in other countries.

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BACKGROUND: The social acceptance of IVF has had the effect of shifting the focus of discussion from the earlier disapproval of IVF to its [un]availability. It has also been suggested that affordable ARTs may stop the falling rates of population turnover in Europe. As many couples cannot afford it, let alone in developing countries, there are ongoing efforts to make IVF 'cheaper' and 'affordable'. OBJECTIVES: This paper reviews IVF policies in several countries before focusing particularly on the exceptional policy of the ARTs in Israel. It analyses the effectiveness of IVF cycles over time as reflected in the literature; examines women's health and welfare after long-term IVF use; and asks whether in a scheme of unlimited free-access to IVF, women would necessarily be better off. METHODS: Review of the literature dealing with IVF outcomes, policies and practices. RESULTS: Long-term effectiveness with IVF is unclear. Age and the number of unsuccessful IVF cycles are predictive of a negative outcome, which is at odds with the Israeli policy of open-ended rounds. Women's health and welfare after long-term IVF remains unclear. In a scheme of unlimited free-access to IVF--in a pro-natalist country--women may end up worse-off. CONCLUSIONS: A systematic long-term assessment of the health and welfare of the women after IVF--especially after prolonged treatment with IVF--is necessary to develop a reliable, effective and evidence-based policy on assisted reproduction not only in Israel, but also in other countries.

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Policies on reproduction have become an increasingly important tool for governments seeking to meet the so-called demographic 'challenge' created by the combination of low fertility and lengthening life expectancies. However, the tension between the state and the market in health care is present in all countries around the world due to the scare resources available and the understandable importance of the health issues. The field of assisted reproduction, as part of the health care system, is affected by this tension with both-the state's and the market's involvements-carrying important implications. Bulgaria and Israel share the same size of population, are markedly paternalistic and both have strong pro-natalist cultures by which large families are expected. For a range of reasons the two countries contrast sharply, however, in terms of their capacity to intervene in the health system, and also in terms of the political will to act on matters of reproduction. This paper examines how assisted reproduction, as reflected by present policies in both countries, influences women's welfare and considers whose interests the practices of assisted reproduction in these countries actually serve. By reviewing some of the present data on women's status in Bulgaria and Israel and assessing both states' policies and involvement in assisted reproduction this paper helps to identify some of the intended and unintended consequences of assisted reproduction policies in different countries.

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This paper argues that stem cells, with their ability to replace damaged tissues and organs may open new horizons for prolonging-life therapies. The article suggests that stopping this research is improbable and also undesirable, because if successful, millions of people will greatly benefit. On the other hand, this progression in curing disease may result in prolonging life, possibly indefinitely. This paper explores notions of human indefinitely prolonged life (IPL)--assuming that IPL maintains people's health and full capabilities--and suggests that existing claims against IPL, such as overpopulation, reduced brain capacity and possible personal boredom, do not justify avoiding IPL when, and if it becomes available. Nor does global justice require people from developed societies to give up their lives. It concludes however, that, although we should not prevent people from living longer lives, new schemes of morality should be developed under this perspective.

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In this paper, I argue that the development of an artificial womb is already well on its way. By putting together pieces of information arising from new scientific advances in different areas, (neo-natal care, gynecology, embryology, the human genome project and computer science), I delineate a distinctive picture, which clearly suggests that the artificial womb may become a reality sooner than we may think. Currently, there is a huge gap between the first stages of gestation (using in vitro fertilization) and the 22nd week (inside the womb). At the present time this gap seems an insurmountable barrier for fully developing a fetus outside a natural womb - a notion better known as ectogenesis. The history of science however, suggests that impenetrable barriers are such only temporarily. It is just a matter of time (and due research) until someone - intentionally or by chance - accesses the right answer and finds a way to overcome existing obstacles. Despite misgivings that the case of the artificial womb presents too many barriers, it would be naive to suppose things would happen any differently. I observe in this paper, that it is time to acknowledge the consequences of new developments in different areas of scientific research which are leading to the advent of an artificial womb; and I modestly suggest that we might initiate a discussion on this topic now, while we have still enough time to decide what we may want and why.

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During 2002, the Human Fertilization and Embryology Authority (HFEA) in England, which regulates in vitro fertilization (IVF) clinics, agreed to allow a family to attempt to create a baby genetically selected to help treat a desperately ill child. The media reaction against this HFEA decision has shown profound outrage, expressing that having a child for the sake of the other is improper, immoral and 'against human dignity'. Other claims were, "we should protect vulnerable human life", and "human beings should not be treated 'as a means to an end"'. None of these moral claims however, stand rational and coherent scrutiny. Thus, this paper maintains that making a child to save the life of his brother is not only ethically permissible but it would rather be unethical NOT to do so.

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While some claim that germ-line engineering is a definite possibility, the law in Israel and in most countries states that it should be avoided. This paper suggests that using GLE in order to 'self-evolve' (when it becomes safe) is not only inevitable but also morally justified. This paper argues that, The great achievements of healthcare during the last century, enabling longer life, have made almost everyone prey to late-onset diseases. The conundrum of healthcare allocation is worsening, partly due to late-onset dysfunctional genes that have escaped the barriers of natural selection, Trying to free future generations from late-onset diseases (such as Alzheimer's for instance) may be considered as 'eugenics' but, if pursued freely and justly, is a noble goal. We will be affecting future generations whether or not we use GLE. By definition, GLE might be reversible; it follows therefore that GLE may not necessarily represent the dramatic change inserted in the germ line forever--as is usually suggested. Reproductive freedom and justice are paramount in this scenario. These values are not necessarily incompatible if the right policies are in place.

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