The abrupt demise of the AMA Journal of Ethics

Medical ethics is full of twists and turns, so it is perhaps fitting that the American Medical Association killed its Journal of Ethics, without explanation, in an abrupt announcement in its November issue that the December issue would be the last issue. 

From the Editor in Chief, AMA Journal of Ethics, Nov 2025
Breaking Bad News, Audiey C. Kao, MD, PhD

"For over a quarter of a century, the AMA Journal of Ethics has striven to publish insightful commentaries, engaging podcasts, and provocative artwork that help medical students, physicians, and all health care professionals reflect on and make sound ethical decisions in service to patients and society. I write to inform you that the AMA Journal of Ethics will cease publishing new content after December 2025. Understandably, this news will be sad and unexpected for the journal’s readers and supporters. I share in this loss.

"Previously published content will be maintained on the journal’s website and remain freely available to all in keeping with our guiding premise that ethics inquiry is a public good. With humility, I am hopeful and confident that this archived journal content will stay evergreen for years to come. "

######

Here's an article in MedpageToday, mourning the demise of the journal in a way that appears to have left authors of forthcoming articles in the lurch:

In Memoriam: The Sudden Demise of the AMA Journal of Ethics
— A great loss for physicians, the profession, and the public
by Matthew Wynia, MD, MPH, and Kayhan Parsi, JD, PhD

"without warning, the American Medical Association (AMA) announced that it would cease publishing AMA JoE after the December 2025 issue. Journals like AMA JoE operate a year or more in advance, so multiple authors and editors of upcoming issues for 2026-2027 were left in the lurch by this unexpected announcement. Students and trainees are now scrambling to find new homes for their articles, some of which have already undergone extensive editorial review."
 

Ethical considerations and global cooperaton in transplantation, Wednesday in Cairo

It's Wednesday morning in Cairo, and here's today's conference schedule, which will include discussion of (and voting on) global cooperation in transplantation. (See my earlier post for context.) 

 

8:00 AM 08:30 AM	Opening Session of Ethical Consensus Global Consensus on Emerging Ethical Frontiers in Transplantation: Innovations & Global Collaboration	HALL A
Strategic Co-Leaders (Alphabetical)	Alvin E. Roth (Stanford University, USA) John Fung (University of Chicago, USA) Mark Ghobrial (Methodist Hospital, Houston, USA) Osama A Gaber (Methodist Hospital, Houston, USA) Sandy Feng (UCSF, USA) Valeria Mas (University of Maryland, USA)
Chairs (Alphabetical)	Ahmed Elsabbagh (University of Pittsburgh, USA) Medhat Askar (Baylor University, USA) Mohamed Ghaly (Hamad Bin Khalifa University, Qatar) Mohamed Hussein (National Guard Hospital, KSA)
Scientific Committee (Alphabetical)	Abdul Rahman Hakeem (King’s College Hospital, UK) Dieter Broering (KFSHRC, KSA) Hermien Hartog (Groningen, the Netherlands) Hosam Hamed (Mansoura University, Egypt) Manuel Rodriguez (Universidad Nacional Autónoma de México, Mexico) Matthew Liao (Center for Bioethics, New York University, USA) Nadey Hakim (King’s College, Dubai, UAE) Stefan Tullius (Harvard Medical School, USA) Varia Kirchner (Stanford University, USA) Wojciech Polak (Erasmus Medical Center, Rotterdam, the Netherlands)
Leadership of Jury Committee (Alphabetical)	Chair: John Fung (University of Chicago, USA) Vice-Chairs Hatem Amer (Mayo Clinic, Rochester, USA) Lloyd Ratner (Columbia University, USA) Maye Hassaballa (Cairo University, Egypt)
08:30 AM 09:30 AM	State of Art Lecture (1, 2)	HALL A
Chairpersons (Alphabetical)	Mahmoud El-Meteini (Ain Shams University, Egypt) Mehmet Haberal (Baskent University, Turkey) Sandy Feng (UCSF, USA)
08:30 AM 09:00 AM	From Dr. Starzl to the Future: The Evolution of Transplantation and the Call to Continue the Journey John Fung (University of Chicago, USA)
09:00 AM 09:30 AM	Organ Transplant Ethics: How Technoscientific Developments Challenge Us to Reaffirm the Status of the Human Body so as to Navigate Innovation in a Responsible Manner Hub A.E. Zwart (Erasmus University Rotterdam, Netherlands)
09:30 AM 11:00 AM	Working Group 1:	HALL A
Chairpersons (Alphabetical)	Ali Alobaidli (Chairman of UAE National transplant committee) Hermien Hartog (Groningen, The Netherlands) Khalid Amer (Military Medical Academy, Egypt) Lloyd Ratner (Columbia University, NY, USA) Thomas Müller (University Hospital Zurich, Switzerland)
09:30 AM 09:50 AM	Keynote Lecture: Xenotransplantation: Scientific Milestones, Clinical Trials, Risks, and Opportunities Jay Fishman (MGH, USA)
09:50 AM 11:00 AM	WG1 Presentation & Panel Voting Matthew Liao (Center for Bioethics, New York University, USA) Hosam Hamed (Mansoura University, Egypt) Daniel fogal (New York University, USA)
11:00 AM 11:30 AM	Coffee Break
11:30 AM 01:00 PM	Working Group 2:	HALL A
Chairpersons (Alphabetical)	Daniel Maluf (University of Maryland, USA) Karim Soliman (University of Pittsburgh, USA) Marleen Eijkholt (Leiden University Medical Centre, Netherlands) Refaat Kamel (Ain Shams University, Egypt) Varia Krichner (Stanford University, USA)
11:30 AM 11:50 AM	Keynote Lecture: Smart Transplant: How AI & Machine Learning Are Shaping the Future Dorry Segev (NYU Langone, USA)
11:50 AM 01:00 PM	WG2 Presentation & Panel Voting Hub A.E. Zwart (Erasmus University Rotterdam, Netherlands) Varia Krichner (Stanford University, USA) Eman Elsabbagh (Duke University, USA) Mohammad Alexanderani (University of Pittsburgh, USA)
01:00 PM 02:30 PM	Working Group 3:	HALL A
Chairpersons (Alphabetical)	Ahmed Marwan (Mansoura University, Egypt) Ashraf S Abou El Ela (Michigan, USA) Mostafa El Shazly (Cairo University, Egypt) Peter Abt (UPenn, USA) Philipp Dutkowski (University Hospital Basel, Switzerland)
01:00 PM 01:20 PM	Keynote Lecture: Ischemia-Free Transplantation: A New Paradigm in Organ Preservation and Transplant Medicine Zhiyong Guo (The First Affiliated Hospital of Sun Yat-sen University, China)
01:20 PM 02:30 PM	WG3 Presentation & Panel Voting Jeffrey Pannekoek (Center for Bioethics, Cleveland Clinic, USA) Abdul Rahman Hakeem (King’s College Hospital, UK) Georgina Morley (Center for Bioethics, Cleveland Clinic, USA)
02:30 PM 03:30 PM	Lunch Symposium	HALL B
03:30 PM 05:00 PM	Working Group 4:	HALL A
Chairpersons (Alphabetical)	David Thomson (Cape Town University, South Africa) Lucrezia Furian (University Hospital of Padova, Italy) May Hassaballa (Cairo University, Egypt) Abidemi Omonisi (Ekiti State University, Nigeri) Vivek Kute (IKDRC-ITS, Ahmedabad, India)
03:30 PM 03:50 PM	Keynote Lecture: Framing the Conversation: Ethical considerations at the foundation for global transplant collaboration Marleen Eijkholt (Leiden University Medical Centre, Netherlands)
03:50 PM 05:00 PM	WG4 Presentation & Panel Voting Alvin Roth (Stanford University, USA) Marleen Eijkholt (Leiden University Medical Centre, Netherlands) Michael Rees (University of Toledo, USA) Ahmed Elsabbagh (University of Pittsburgh, USA) Nikolas Stratopoulos (Leiden University Medical Centre, Netherlands)
05:00 PM 05:30 PM	Closing Session of Ethical Consensus Global Consensus on Emerging Ethical Frontiers in Transplantation: Innovations & Global Collaboration	HALL A
Strategic Co-Leaders (Alphabetical)	Alvin E. Roth (Stanford University, USA) John Fung (University of Chicago, USA) Mark Ghobrial (Methodist Hospital, Houston, USA) Osama A Gaber (Methodist Hospital, Houston, USA) Sandy Feng (UCSF, USA) Valeria Mas (University of Maryland, USA)
Chairs (Alphabetical)	Ahmed Elsabbagh (University of Pittsburgh, USA) Medhat Askar (Baylor University, USA) Mohamed Ghaly (Hamad Bin Khalifa University, Qatar)
05:10 PM 05:30 PM	State of Art Lecture (3): Reflections from a Transplant Pioneer: Ethics, Policy, and the Future of Global Collaboration Ignazio R. Marino (Thomas Jefferson University, Italy/USA)

 

Join the global call for change at DLE--Invitation to Cairo

  After being invited to this week's International Transplant Week in Egypt, , I was invited to invite others.

 (To hear my very brief invitation, which the conference published on Instagram, you may have to click on the speaker symbol in the lower right corner of the image.)

 

View this post on Instagram

A post shared by Folder Group (@foldermiddleeast)

 

International Transplant Week in Egypt, 2025

 I'm preparing to spend next week in Cairo at the Donate Life Egypt 2025 International Transplant Week, where I'll give a talk on Thursday.  But much of my preparation is for Wednesday, when something potentially much more exciting is scheduled.

 

 

Wednesday (Nov. 12) will be devoted to an attempt to reach a new Global Consensus on Emerging Ethical Frontiers in Transplantation: Innovations & Global Collaboration

I'll be involved in Working Group 4: Ethical Frameworks for Regulated International Collaboration
 

Co-Chairs

    Prof. Alvin Roth — Stanford University, USA
    Dr. Michael Rees — University of Toledo, USA
    Prof. Marleen Eijkholt — Leiden University Medical Centre, Netherlands

Scientific Committee Liaison / Editorial Lead

    Dr. Ahmed Elsabbagh — University of Pittsburgh, USA<

Members (alphabetical)

    Dr. Ali Obaidli — Department of Health, Abu Dhabi, UAE
    Dr. David Thomson — University of Cape Town, South Africa
    Dr. Frederike Ambagtsheer — Erasmus University Rotterdam, Netherlands
    Dr. Gustavo Ferreira — University of São Paulo, Brazil
    Prof. Ignazio Marino — Thomas Jefferson University, Italy/USA
    Dr. Juan Navarro — Leiden University Medical Centre, Netherlands
    Dr. Lucrezia Furian — University of Padua, Italy
    Dr. Manuel Rodríguez — UNAM, Mexico (President of SPLIT)
    Dr. Mignon McCulloch — University of Cape Town, South Africa
    Dr. Nikolas Stratopoulos — Leiden UMC, Netherlands
    Dr. Vivek Kute — IKDRC-ITS, India
    Dr. Wendy Spearman — University of Cape Town, South Africa

It may be a long shot, but my hope is we can reach some consensus to replace the longstanding dogma that countries should be self-sufficient in transplantation.
 

Repugnance and consequence-insensitivity (in connection to opposition to genetically-engineered food)

 There is a well developed literature on repugnance connected to food, and here is a recent, interesting example that focuses on the relationship between consequence-insensitivity and other correlates of moral outrage.

Inbar, Yoel, Sydney E. Scott, and Paul Rozin. "Moral opposition to genetically engineered food in the United States, France, and Germany." Annals of the New York Academy of Sciences (2025). 

 ABSTRACT: "When people are morally opposed to a practice, they often profess to be consequence-insensitive—that is, they say that they think it ought to be prohibited regardless of the risks and benefits. We investigate consequence-insensitive opposition to genetically engineered (GE) food in France, Germany, and the United States. Using nationally representative samples (total N = 1599), we find that most GE food opponents in all three countries are consequence-insensitive (France: 93.1%; Germany: 87.4%; United States: 81.3%). Consequence-insensitive opponents differ from other opponents in other ways consistent with their holding moral beliefs. They are more likely to display other properties of sacred moral values, like quantity insensitivity and universalism. They also see GE food as more personally important, are less willing to consume it, are more in favor of policies restricting it, and are more willing to engage in activism against it."

 

"In their research on moral GE food opposition in the United States, Scott et al. [15] asked par “It is equally wrong to allow some of this to happen as to allow twice as much to happen. The amount doesn't matter” (quantity insensitivity); and “This would be wrong even in a country where everyone thought it was not wrong” (universalism)ticipants three questions that were originally developed by Baron and Spranca [14] for their research on sacred values (which they call “protected values”). Scott et al.’s primary analyses focused on the consequence-insensitivity question, which asked whether GE food “should be prohibited no matter how great the benefits and minor the risks from allowing it.” Likewise, we here focus on the consequence-insensitivity item and test whether responses to other questions theoretically related to sacred values differ between consequence-sensitive and consequence-insensitive opponents. In the current study, we used two other items related to sacred values that were previously used in Scott et al.: “It is equally wrong to allow some of this to happen as to allow twice as much to happen. The amount doesn't matter” (quantity insensitivity); and “This would be wrong even in a country where everyone thought it was not wrong” (universalism). We also added two new exploratory items that were intended to tap moral outrage at the juxtaposition of secular (financial) considerations with sacred values [19]: “I am offended by the idea of putting a monetary price on allowing this”; and “It is morally wrong to put a monetary price on allowing this practice.” For each of these items, we test whether responses differ between consequence-sensitive and consequence-insensitive opponents. If consequence-insensitive opponents are more likely to display quantity insensitivity, universalism, and moral outrage at sacred-secular tradeoffs than consequence-sensitive opponents, then this would provide further evidence that consequence-insensitive opponents moralize GE food more than consequence-sensitive opponents."
 

Recommendations From the International Society of Uterus Transplantation Ethics Committee

 The arc of history turns towards technology.

I didn't expect recommendation #2, although I've heard it discussed. 

Evolving Ethical Challenges After a Decade of Uterus Transplantation: Recommendations From the International Society of Uterus Transplantation Ethics Committee
by Wall, Anji E. MD, PhD1; Brännström, Mats MD, PhD2; Lotz, Mianna PhD3; Racowsky, Catherine PhD4; Stock, Peter MD, PhD5; Järvholm, Stina PhD2; Sustek, Petr PhD6; Brucker, Sara MD, PhD7; Tullius, Stefan G.8;  on behalf of The International Society of Uterus Transplantation Ethics Committee and endorsed by The Transplantation Society Ethics Committee*
Transplantation, August 26, 2025. | DOI: 10.1097/TP.0000000000005507 

---

Abstract:Uterus transplantation (UTx) became a clinical reality with the birth of the first baby in 2014. Following increased success, the procedure has now transitioned to clinical practice in many institutions throughout the world. With a rising number of donors, recipients, and babies born from this procedure, and with more institutions offering UTx, ethical challenges have evolved while novel aspects gained prominence. Here, the Ethics Committees of the International Uterus Transplantation Society, a section of The Transplantation Society, summarize current and future ethical challenges in UTx and provide recommendations for addressing these challenges. Ethical considerations covered here span (i) donor and recipient selection, (ii) living versus deceased donation, (iii) use of assisted reproductive technologies, (iv) informed consent, (v) clinical provision of UTx, and (vi) research protocols for further studies of UTx. For each topic considered, ethical analysis and recommendations are offered to ensure the practice of UTx remains within an acceptable foundational ethical framework that balances respect for autonomy, beneficence, and justice.

...

"Recommendation 2: Animal research is needed to determine the feasibility of UTx in, and uterus donation from, transgender patients and UTx in cisgender males who want to experience pregnancy. If medically and surgically acceptable, gender identity and reproductive status should not be exclusionary factors for uterus donation or transplantation." 

Where snitches make pitches--Corporate hotlines for ethics violations

 The WSJ has this story on the business of corporate hotlines for whistleblowers to report potential ethics violations.

Sex Scandals. Accounting Fraud. It’s All Showing Up on the Corporate Hotline.
A tip left on such a hotline led to the ouster of the Nestlé CEO. For affairs or minor office annoyances, operators are standing by.
By  Lauren Weber, Margot Patrick,  and Chip Cutter

"It’s an industry operating under the premise that companies run better when workers can safely sound the alarm on everything from bad breath to bribery. The task is often farmed out to third parties with names like SpeakUp, Navex and EQS.

"SpeakUp, based in Amsterdam, helps operate Nestlé’s line. In 2024, it handled 3,218 calls and messages with allegations ranging from bullying and harassment to fraud and conflicts of interest at Nestlé and its suppliers. Nestlé says it substantiated 20% of them, and 119 people left their jobs as a result.

“Hotlines are magic,” said Raheela Anwar, president and CEO of Group 360 Consulting, a Chicago-based corporate advisory firm. “Because people are willing to tell the truth.”

"At public companies, they’re also required. The post-Enron Sarbanes-Oxley financial reforms passed in 2002 mandated that companies have a process for whistleblowers to report potential ethics violations. A 2019 European Union directive does the same. More than 90% of U.S. firms with at least 1,000 employees provide a hotline for workers, according to HR Acuity, a company that helps employers track internal investigations and includes employee hotlines among its offerings. "

Ethical compensation for research participants: an open letter

 Institutional review boards (IRBs) are often faced with the question of whether research participants should or must be compensated, and how much.  In the medical ethics community there is often a presumption that there are ethical reasons not to offer participants too much compensation. This is a very different intuition from the more general notion (embodied e.g. in minimum wage laws) that there are ethical reasons not to offer too little compensation.

I'm one of 64 signers of an open letter about this...

Abadie, R. et al. (2025) ‘Pursuing Fair and Just Compensation for Research Participants: An Open Letter to the Research Ethics Community’, The American Journal of Bioethics, pp. 1–5. doi: 10.1080/15265161.2025.2506328.
 

"We, the 64 undersigned, from fields including philosophy, law, medicine, policy, public health, patient advocacy, and research ethics, offer this open letter to highlight the growing recognition of the pitfalls of excessive concern over payment to research participants. Experts in the field of research oversight, including institutional review boards/research ethics committees (IRB/RECs), now recognize that for adult participants capable of providing their own informed consent, instances of monetary undue influence are generally quite rare, underpayment is far more common and ethically concerning than overpayment, and that lowering payments threatens justice and fairness without providing substantive protection for participants.

...

"Absent strong evidence that monetary payment will lead to undue influence, it is likely that more harm than good is done by lowering compensation levels for a given study. Research participation generates immense social value, and generous compensation can reflect this value and serve as an important sign of respect and appreciation for participants (Fernandez Lynch et al. Citation2021).

...

"Concern over undue influence through monetary compensation, while well intended, receives outsized attention, even at the expense of other ethical issues. Ultimately, there must be very strong rationale when suggesting such limits for an otherwise approved study, and attempts to limit payment based on the potential for undue influence should be scrutinized especially closely. IRBs/RECs should still keep in mind the amount of time required and burden on participants to ensure at least a minimum standard of compensation is met. At times, they should even require sponsors or investigators to increase compensation amounts when what they are proposing is insufficient. It is high time that the default question shift from “is this payment too much?” to “is this enough?” in clinical trials."

 

Signed by:

Roberto Abadie    Assistant Professor, University of Wisconsin-Madison Department of Kinesiology
Adam L. Anderson    Associate Professor of Medicine, Washington University in St. Louis
Emily E. Anderson    Professor of Bioethics, Loyola University Stritch School of Medicine
Andrew Berman    Professor of Medicine, Rutgers New Jersey Medical School
Barbara Bierer    Professor of Medicine, Harvard Medical School, and Faculty Director, MRCT Center
François Bompart    Member, INSERM Ethics Committee (France)
Brandon Brown    Professor of Medicine, University of California, Riverside, School of Medicine
Arthur Caplan    Head, Division of Medical Ethics, NYU Grossman School of Medicine
Carolyn Riley Chapman    Lead Investigator/Faculty, Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital and Harvard
Coalition for Clinical Trial Equity
Alexandra Collins    Assistant Professor of Community Health, Tufts University
Marci Cottingham    Associate Professor of Sociology, Kenyon College
Stephanie Solomon Cargill    Associate Professor of Research Ethics, Albany Medical College
Arlene M. Davis    Professor of Social Medicine, UNC School of Medicine
David DeGrazia    Elton Professor of Philosophy, George Washington University
David Diemert    Professor of Medicine, George Washington University
Anna Durbin    Professor, Johns Hopkins Bloomberg School of Public Health
Jake Earl    Adjunct Lecturer in Philosophy, Georgetown University
Jake D. Eberts    Member of the Board of Directors, 1Day Sooner
Gunnar Esiason    Head of Patient Engagement & Patient-Centered Innovation, RA Ventures
James A. Feldman    Professor of Emergency Medicine, Boston University School of Medicine
Holly Fernandez Lynch    Associate Professor of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine
Susan S. Fish    Professor, Boston University Chobanian & Avedisian School of Medicine
Celia B. Fisher    Marie Ward Doty Endowed University Chair in Ethics and Professor of Psychology
Jill A. Fisher    Professor of Social Medicine, UNC Center for Bioethics
Allison Foss    Executive Director, Myasthenia Gravis Association
Foundation for Sarcoidosis Research
Luke Gelinas    Senior IRB Chair Director, Advarra
Kevin Griffith    Assistant Professor of Health Policy, Vanderbilt University
Marielle Gross    Founder/ceo, de-bi, co; Faculty, Johns Hopkins Berman Institute of Bioethics
Scott D. Halpern    John M. Eisenberg Professor in Medicine, University of Pennsylvania
Logan Harper    ILD & Sarcoidosis Center, Cleveland Clinic, Assistant Professor of Medicine, CCLCM/CWRU School of Medicine
David A. Heagerty    Associate Director, University of Pennsylvania IRB
Kristin Hermann    Executive Vice President, Strategic Accounts, Scout
W. Ennis James    Associate Professor of Medicine and Sarcoidosis Program Director, Medical University of South Carolina
Steven Joffe    Art and Ilene Penn Professor and Chair of Medical Ethics & Health Policy, University of Pennsylvania Perelman School of Medicine
Nancy M. P. King    Emeritus Professor, Wake Forest University School of Medicine
Stephanie A. Kraft    Assistant Professor, Geisinger College of Health Sciences
Walter K. Kraft    Professor, Thomas Jefferson University
Benjamin Krohmal    Assistant Professor, Georgetown University School of Medicine
Emily A. Largent    Associate Professor of Medical Ethics, University of Pennsylvania Perelman School of Medicine
Anne Drapkin Lyerly    Professor of Social Medicine, University of North Carolina at Chapel Hill
Lazarex Cancer Foundation
Dylan Matthews    Senior Correspondent, Vox
Lindsay McNair    Principal Consultant, Equipoise Consulting
Josh Morrison    President, 1Day Sooner
Joseph Millum    Senior Lecturer, University of St Andrews
Torin Monahan    Professor, University of North Carolina at Chapel Hill
Axel Ockenfels    Professor of Economics at the University of Cologne and Director at the Max Planck Institute for Research on Collective Goods in Bonn
Joshua Osowicki    Infectious diseases physician and Team Leader, Murdoch Children’s Research Institute, Melbourne, Australia
Leah Pierson    MD/PhD candidate, Harvard Medical School; Cohost of the Bio(un)ethical podcast
Jessica Propps    Caregiver Advocate, Foundation for Sarcoidosis Research
Jeanne M. Regnante    Principal, Patient 3i, LLC
David B. Resnik    Bioethicist
Donald Richardson    Cardiovascular Disease Fellow, Cedars-Sinai Medical Center
Alvin Roth    Craig and Susan McCaw Professor of Economics, Stanford University
Julian Savulescu    Professor of Medical Ethics, National University of Singapore
Scout Clinical    
Peter H. S. Sporn    Professor of Medicine, Northwestern University Feinberg School of Medicine
Kawsar Talaat    Associate Professor, Johns Hopkins Bloomberg School of Public Health
Rebecca L. Walker    Professor of Philosophy and of Social Medicine, University of North Carolina at Chapel Hill
Margaret Waltz    Research Associate, University of North Carolina at Chapel Hill
Kathryn Washington    Sarcoidosis patient advocate
Sarah A. White    Executive Director, The Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital and Harvard
Megan M. Wood    Assistant Professor of Communication and Media, Ohio Northern University

 

Thinking about the ethical, legal and political relationships between IVF and abortion (in JAMA)

Some people support both IVF and abortion (women's right to choose) and some people oppose both (embryos are people), but many oppose abortion but support IVF.  Here's an article that focuses on some ethical distinctions (is the intention to have a child or not), and also on some political ones (IVF patients are on average more affluent than abortion patients).

Watson K. Rethinking the Ethical and Legal Relationship Between IVF and Abortion. JAMA. Published online May 22, 2025. doi:10.1001/jama.2025.6733 

"US voters have elected a president who promised he would make the government or private insurance cover in vitro fertilization (IVF), yet takes credit for reversing Roe v Wade. These positions highlight a question that has lingered since US IVF practice began in 1981: are hospital and governmental policies that support IVF but do not support abortion ethically consistent? And if not, why is this division so common?

"Those who see IVF and abortion as ethically distinct often focus on differences in intention and outcome—having a baby vs avoiding having a baby. Others see them as comparable practices because both destroy embryos. I offer a third perspective, which is that abortion and IVF are comparable practices because both are family-building medical interventions; therefore, support for IVF access ought to lead to support for abortion access.

"Abortion was a federal constitutional right until 2022, and IVF was subject to state regulation like the rest of medicine. Yet constitutional protection did not stop many states from heavily regulating abortion, and IVF rarely faced governmental limits. A stark example of their disparate treatment occurred shortly after Roe v Wade was reversed when the traditionally antiabortion state of Indiana began its statute criminalizing abortion provision by clarifying “This article does not apply to in vitro fertilization” (IN Code §16-34-1-0.5 [2024]).

"Yet like abortion, IVF also involves embryo death. 

...

" differences in patient income, race, age, and education also suggest a stark difference in political power between the constituencies invested in IVF and abortion. Eighty-one percent of fertility patients have household incomes of more than $100 000 and 75% are White6; 72% of abortion patients have incomes less than 200% of the federal poverty line and 59% are Black or Latinx.3 Sixty-four percent of IVF patients are 35 years or older,7 while 70% of abortion patients are in their teens or 20s.3 Fourteen percent of births to women with a college or graduate degree were conceived with the use of assisted reproductive technology, but only 1.5% of births to women with some college or less were conceived with assisted reproductive technology in 2023.8 In contrast, 77% of abortion patients have some college or less.9 (There are no data documenting how many IVF patients deferred their childbearing by having an abortion when they were younger, or how many IVF patients later abort to decrease a multiple pregnancy or avoid unexpected medical problems.)

"Entities involved in providing IVF also have financial interests in preserving the legality of a practice with a median cost of $19 200 per cycle.6 Infertility care generates approximately $8 billion per year in gross revenues in the US.10 High operating margins have drawn private equity investors to many private fertility practices, and IVF is lucrative for hospitals and physicians."

The debate over compensating organ donors is heating up

  It's a new year, and maybe there will be progress in increasing organ donation.  Here's a video in which Elaine Perlman explains the End Kidney Deaths Act, which might be debated by Congress this year, and would be an attempt to increase living donation by allowing some compensation (in the form of tax credits) for kidney donation.  And there are  a slew of articles in medical journals (of which I sample two) saying that the first and most important rule of organ transplantation is that donors should not be compensated (and that the same goes for other SoHOs (Substances of Human Origin) such as blood plasma. 

 

"Passing the End Kidney Deaths Act isn’t just an ethical decision—it’s a practical solution to one of the most pressing public health challenges in America.
100,000 Americans are counting on us to get the End Kidney Deaths Act to the finish line. The choice is clear and 2025 is our year. Let’s contact Congress now to pass the End Kidney Deaths Act and ensure a future where no one dies while waiting for a kidney. Because saving lives is not only ethical—it’s our responsibility."

#########

And here are two articles reaffirming their opposition:

Promoting Equitable and Affordable Patient Access to Safe and Effective Innovations in Donation and Transplantation of Substances of Human Origin and Derived Therapies
Cuende, Natividad MD, MPH, PhD1; Tullius, Stefan G. MD, PhD2; Izeta, Ander PhD3; Plattner, Verena PhD4; Börgel, MSc, Martin5; Ciccocioppo, Rachele MD6; Correa-Rocha, Rafael PhD7; Koh, Mickey B. C. MD, PhD8,9; De Angelis, Vincenzo MD10; Gondolesi, Gabriel E. MD, MAAC11; ten Ham, Renske PhD, PharmD12; Porte, Robert J. MD, PhD13; Hernández-Maraver, Dolores MD, PhD14; Hawthorne, Wayne J. MD, PhD15; Sureda, Anna MD, PhD16; Orlando, Giuseppe MD, PhD17; Haraldsson, Börje MD, PhD18; Ascher, Nancy L. MD, PhD19; Dominguez-Gil, Beatriz MD, PhD14; Oniscu, Gabriel C. MBChB, MD20
Author Information
Transplantation 109(1):p 36-47, January 2025. | DOI: 10.1097/TP.0000000000005169

 Note which ethical principle is at the top of the list.

###########

And this report speaks of global kidney exchange, but not for the poor...

 Expanding Opportunities for Living Donation: Recommendations From the 2023 Santander Summit to Ensure Donor Protections, Informed Decision Making, and Equitable Access, by
Lentine, Krista L. MD, PhD1; Waterman, Amy D. PhD2; Cooper, Matthew MD3; Nagral, Sanjay MS, FACS4; Gardiner, Dale MD5; Spiro, Michael MBBS6; Rela, Mohamed MS, FRCS, DSc7; Danovitch, Gabriel MD8; Watson, Christopher J. E. MD9; Thomson, David MD10; Van Assche, Kristof PhD11; Torres, Martín MD, MS12; Domínguez-Gil, Beatriz MD, PhD13; Delmonico, Francis L. MD14;  On behalf of the Donation Workgroup Collaborators*
Transplantation 109(1):p 22-35, January 2025. | DOI: 10.1097/TP.0000000000005124

 

"International KPE is acceptable if the donor-recipient pairs belong to a similar sociodemographic reality and are properly covered and protected by healthcare systems. GKE that exploits financial inequalities between pairs (or countries) must be prohibited."