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This is in contrast to prenatal screening policies which propose eVorts to prevent and avoid diYculties generic 60 caps diabecon with amex, as if human beings cannot or should not have to experience them generic diabecon 60caps with amex, and as if disability is not inevitable for most human beings effective diabecon 60caps, at least at the beginning and end of life. The interviewees quoted earlier suggest that this approach is unrealistic, because ordinary people’s lives so often involve problems – such as with relationships, loss, frustrating limitations or poverty. Fearful avoidance of disability, rather than promoting ways to support disabled people’s lives, is liable to diminish people rather than freeing them into new achievement and conWdence. The diYculty in these criteria is the current limitations in predicting how severe an impairment might be or might become, how much it may be ameliorated by social or medical support, and how the aVected person and family may experience similar diYculties either as hardship and suVering or as part of a worthwhile rewarding life. Some parents value their Prenatal counselling and images of disability 209 child’s very short life far more than no life at all (Delight and Goodall, 1990). Unawareness may include unawareness of suVering, which would obviate the criterion of suVering, and uncertainty again prevails over the diagnosis and prognosis of unawareness. Children who have been dismissed as ‘vegetables’ are perceived by others to experience profound feelings, such as by the researcher who commented, ‘Cabbages do not cry’ (Oswin, 1971). The argument that prenatal selection is diVerent from ending such lives after birth, and aVects attitudes towards impaired fetuses only, is unconvincing. The interviewees show that some disabled people feel threatened and disad- vantaged by the prejudices which are, perhaps inadvertently, promoted through prenatal screening. The emphasis on particular impairments when selecting an embryo or fetus as worth preserving suggests that any policy diVerence between preserving an embryo or a person with, say, thalassaemia is not one of principle but of practicality. Social exclusion, school exclusion and family exclusion (in numbers of teenagers living on the streets) are increasing rapidly, as are expectations that children should conform to ever more speciWc milestones, school tests and behaviour standards with an unjust ‘zero-tolerance’ which does not allow for contingencies and disadvantages. Prenatal programmes are not responsible for these changes, but they are part of them, and are powerful medical and oYcial indirect endorsements of them. Another theme of injustice is when public rejection, expressed through national prenatal programmes, is made to appear to be a matter of private grief and responsibility, as when each individual woman faces the ‘choice’ of termination of pregnancy, a choice constrained by social and economic circumstances. Tests which screen ‘negatively’ for one or a few speciWc impairments are soon likely to become multi-package tests to screen simultaneously for numerous impair- ments, and then tests to select ‘positively’ for growing numbers of preferred features such as intelligence or height. When the embryo and fetus, and implicitly the baby and child, are presented to women by health professionals as a means of fulWlling adults’ dreams of perfection, rather than as ordinarily imperfect mortals to love as ends in themselves, then maternal– child as well as maternal–fetal relationships are likely to become ever more tentative and conditional. I am grateful to everyone who took part in the research,and to my co-researchers,although I am responsible for any shortcomings and opinions in this chapter. Over time, the initial way a problem is deWned then crystallizes policy debates, producing what can then become a very rigid framework, all but impossible to expand or modify (Rochefort and Cobb, 1994: vii, pp. Constitutionally, in the course of nearly 30 years of Supreme Court reasoning, abortion rights have become rigidly deWned as a problem of decisional autonomy, that is, as a problem of privacy and choice. Politically, during that same time period, the problem of abortion has been deWned by pro-life activists (as we would expect), but also by pro-choice advocates (as we might not expect) on the basis of a very traditional model of motherhood, one invoking cultural and ethical depictions of women as maternal, self-sacriWcing nurturers. The combination of deWning the problem of abortion rights constitu- tionally in terms of the privacy of choice and politically in terms of a traditional view of motherhood has produced a rigid, serious policy conse- quence – namely, failure to obtain access to abortion services for women in the form of public funding of abortions. Correction of this policy conse- quence requires a redeWnition of the problem of abortion rights from both constitutional and political perspectives, which entails, as part of that re- deWnition, a transformation of the traditional model of motherhood to include nontraditional elements. To understand more clearly what is in- volved in this transformative process, let us review the current status of how a traditional model of motherhood underlies the current way the problem of abortion is deWned. McDonagh Problem definition: constitutionalism and politics In the United States, the Due Process Clause of the Fourteenth Amendment of the Constitution prohibits the state from depriving ‘any person of life, liberty, or property without due process of law’. This Due Process right of privacy has been interpreted by the Supreme Court to mean that a state may not interfere with a person’s choice about whom to marry, how to educate and raise one’s children, or the choice to use contraceptives. When the Supreme Court established the constitutional right to an abortion in Roe v Wade in 1973, it did so by ruling that the Due Process right to privacy was ‘broad enough to encompass a woman’s decision whether or not to terminate her pregnancy’ without interference from the state. This decision was a breakthrough for women’s rights because it immediately struck down nu- merous state laws that had severely limited procurement of an abortion (Ginsburg, 1985; Klarman, 1996). The Court reasoned that because a pregnant woman ‘carries [potential life] within her’, she ‘cannot be isolated in her privacy’ and her ‘privacy is no longer sole’. Thus, in Roe, the Court established that it is constitutional for the state to protect the fetus from the moment of conception and that a pregnant woman’s right of privacy to make a choice to terminate pregnancy can be limited by, or balanced against, the state’s interest in protecting the fetus as a separate entity from the consequences of that choice. Prior to viability, although the state may not prohibit an abortion per se, the state may protect the fetus by requiring restrictive regulations, such as 24-hour waiting periods and informed consent decrees, and by prohibiting the distribution of any information about abortion in publicly funded family planning clinics. What is more, law scholars concur that the Due Process foundation for abortion rights, as interpreted by the Court, means that it would be constitutional for a state to prohibit the use of public resources to assist a woman in obtaining an abortion, even if her pregnancy is subsequent to rape or incest, and even if her pregnancy threatens her with death. After the stage subsequent to viability, the state in promoting its interest in the potentiality of human life may not only prohibit state assistance in obtaining an abortion, but may also prohibit a woman from choosing an Models of motherhood in the abortion debate 215 abortion, ‘except where it is necessary. Thus, although Roe has proved resilient in the ensuing decades for retaining the constitutional right to choose an abortion, deWning the problem of abortion rights in terms of privacy has proved completely inadequate for establishing a constitutional right to state assistance for obtaining one. This is consistent – the Due Process right of privacy to be free of government interference when making choices about one’s own life or reproductive options does not usually include a constitutional right to government assistance in exercising one’s choice. Hence, the constitutional right to choose to use contraceptives, as established in 1965 in Griswold, does not include the constitutional right to government funding to purchase contraceptives. Thus, the constitutional problem with using privacy and the Due Process Clause for deWning abortion rights is that a Due Process depiction of the abortion issue reinforces the Court’s disconnection between the constitu- tional right to an abortion and abortion funding. Since the right to make a choice without government interference – such as the right to choose an abortion or whom to marry – does not include the right to government assistance in exercising that choice, there is little, if any, constitutional leverage to apply to the abortion access issue. When we turn to the political arena, we run into a similar dead-end to procuring access to an abortion, as a result of the problem deWnition of abortion. Based on his experience, he draws attention to the conservative political message developed not only by pro-life activists, but also by the pro-choice community over the last decade. Starting at least in the mid-80s, around the time of the Thornburgh decision, pro-choice activists became so fearful that the right to an abortion would be overturned in court that they began to develop powerful conservative strategies with which to reach out to the American public.

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Here, electronic direct reading dosimeters are advisable to allow continuous knowledge of the total dose. Routine and area monitoring Routine and area monitoring covers regular surveys of the radiation background in critical areas such as the radiopharmacy. These allow practices and safety measures to be modified before staff doses increase, particularly when new radiopharmaceuticals, radionuclides or increased activities are involved. The radiopharmacy should have a permanent area monitor (scintillation counter or ionization chamber), with an audible signal for dose rate, to allow staff to know when radioactive sources are exposed. Typically this would be a radiation safety committee with the responsibility for overseeing radiation safety practices in the hospital, and advising the administration on radiation safety issues. Repre- sentation from the nuclear medicine section is very important and should be mandatory. Often, the nuclear medicine physician or physicist is the only person who can provide expert advice on internal radionuclide dosimetry, and in investigation of radiation incidents where unsealed radionuclides are involved. The committee should have among its responsibilities the following: —Review of staff radiation dose records, especially abnormally high doses; —Review of radiation safety protocols; —Approval of applications for licences under radiation legislation; 520 8. The hospital should also appoint an appropriately qualified and experienced person as the radiation safety officer. Nuclear medicine physicists, physicians or technologists are usually good candidates for this role. While this is common to all medical specialties, it is particularly true for nuclear medicine because of its relationship to, and dependence on, high technology advances. Rapidly developing areas such as electronics, physics, computer sciences, radio- pharmacy and radiochemistry, as well as molecular biology, are closely related to nuclear medicine so that this medical science not only follows developments in such areas but also provides feedback to them. Some particular areas regarding recently achieved advances or future potential ones in nuclear medicine are worth highlighting. The range and benefits of these procedures, both diagnostic and therapeutic, are gaining in both recognition and appreciation. Their role in medical decision making, as part of standard patient care, helps fulfil an otherwise unmet need. The centralization of nuclear medicine and radiopharmaceutical services is leading to a hub and spoke concept. This means that patients may be studied in a peripheral hospital according to the agreed protocols set out in this manual, and the data transferred to a central point for analysis and reporting. This in turn enables nuclear medicine physicians to assist colleagues who work in new centres or in remote areas. Simple telenuclear medicine practice requires an image acquisition site coupled with an image interpretation site. In advanced telenuclear medicine networks, different sites should have the same system configurations to ensure basic compatibility and interoperability, enabling image acquisition, data analysis and data interpretation. It is important, however, to ensure the confidentiality of patient data at all times. The Internet has provided many new opportunities for education in nuclear medicine through distance learning. Universities, scientific societies and international organizations can place a range of teaching resources — slide shows, multimedia teaching packages, relevant textbooks and documents, and digital case study files — on the Internet, for easy access and downloading. Teaching materials on the Internet can be used for both education and on-the- job training in nuclear medicine. Staff members can tailor these materials and design their own purpose made teaching packages. This is particularly useful when there is no Internet connection available or telephone links are too slow for image file transfer. Advances in telecommunications have opened a new horizon for the promotion of nuclear medicine around the world. Telenuclear medicine will continue to develop quickly once some of the problems, such as the issue of licensing, standards, reimbursement, patient confidentiality, telecommuni- cation infrastructure and costs, have been solved. Ultimately, its cost effec- tiveness and far reaching impact will make telenuclear medicine an extremely useful tool, particularly for developing countries. After careful consideration of the local infrastructure, robustness and cost of nuclear and non-nuclear assays, it is likely that bulk reagent methodology will still be the main workhorse of routine diagnostic services. Quality control will remain a key ongoing continuous activity to assure the quality of results. It is well suited to nationwide targeted screening of congenital diseases and other disorders. In more developed countries, the establishment of indigenous immuno- diagnostics will become one of the essential components of a comprehensive biotechnological strategic plan. It will also be used to set up the first workable immunoassay methodology for new analytes before they are thoroughly evaluated and marketed or transformed into other commercial assay formats.