The Social Equity Implications of Uterine Transplant Surgery

According to Penn Medicine, over 70 uterine transplants have been performed globally, providing new hope for women with Uterine Factor Infertility (UFI). Since 2017, institutions like the Penn Transplant Institute and Baylor University Medical Center have pioneered this procedure to provide women struggling with infertility a chance to have biological children. 

Penn Medicine describes UFI as a condition for being born without a uterus, not having a functioning uterus, or having had their uterus removed. According to the NHS, a hysterectomy or the removal of a uterus is often considered for those with heavy periods, endometriosis, pelvic inflammatory disease (PID) or cancer of the uterus or ovaries. Baylor Scott & White Health, outlines that candidates for the transplant must have UFI, be a non-smoker, non-diabetic, cancer-free for at least five years, negative for HIV and hepatitis, and be within child-bearing age, 21-40. The donor – either living or deceased – must be HIV, STD free, be aged 30-50 of a healthy weight, cancer-free for at least five years and have no history of diabetes. 

Penn Medicine describes a uterine transplant as a lengthy procedure which begins with in vitro fertilization (IVF) treatments to harvest and fertilize the patient’s eggs. The uterus is then transplanted and the patient begins to take immunosuppressants, followed by an embryo transfer, and eventually a hysterectomy to remove the transplanted uterus. The entire process takes between two to five years, and women can have up to two children under clinical trials.

UFI affects 5% of all women worldwide. Addressing it is a monumental step towards providing women with more opportunities to have biological children, according to Baylor Scott & White Health. In addition to cis-gendered women, future uterine transplants may provided more reproductive freedom for transgender women who have undergone gender confirmation surgery, according to a recent 2019 study in the U.K. published by the JAMA Network. 

In the same 2019 study surveying transgender women in transgender support groups, over 90% indicated that a uteran transplant would increase their happiness, feelings of femininity, and address gender dysphoria. Access to new technologies for non cis-gendered individuals can break down barriers in healthcare that traditionally cater to cis-gendered people. Transgender individuals are often deprived of fertility preservation counseling and limited in their access to IVF – leaving countless uninformed about assisted reproductive technologies. 

Not surprisingly, social issues come into play.  Although the movement towards more innovative technologies improves the wellbeing of those who are non cis-gendered or those who may be infertile, uterine transplants highlight existing societal and racial inequalies. 

As a white woman, I have an inherent bias towards favoring uterine transplants in those who share both my race and socioeconomic status. Therefore, it is important that I take ample time to realize how reproductive technology may disproportionately impact certain women of color. 

The highest rates of U.S. poverty are experienced by African American, Native American, Alaska Native and Latina women, according to the Center for American Progress. The wealth gap that places women of color in lower socioeconomic environments, prevents access to quality education, healthcare and job opportunities. This often prevents them from accessing invasive, expensive, and new technologies that expand their reproductive choices.

On average, IVF costs between $8,000 to $13,000 per round without medication– effectively limiting low income women from accessing reproductive technologies, according to the Pacific Fertility Center in Los Angeles. Additionally, the use of immunosuppressants – which according to the Cancer Research Institute, causes nausea, increased risk of infection, loss of appetite, vomiting, etc. – may deter women who work full time, work multiple jobs, or have limited opportunities for leave from participating. During the recent pandemic, the increased risk for infection and potential for dangerous exposure to COVID-19 may be a risk many working women of color facing poverty are unwilling to take.

In her novel Intimate Justice: The Black Female Body and the Body Politic, Shatema Threadcraft discusses how women of color have often historically been targeted by coerced sterilization, encouraged to take birth control to reduce their fertility, and have deemed ‘welfare queens’ who through motherhood take advantage of welfare programs. This has culminated in an ingrained pattern in American healthcare to effectively maintain white reproduction. New expensive procedures like uterine transplants are institutionally marketed towards upper-middle class white families which in turn prevents reproduction for women of color who struggle with infertility. 

The inaccessibility of many treatments can also raise the question of if uterine transplants should be covered by subsidized healthcare. For example, in states like California, Medicaid explicitly covers transgender services, which according to the State of California Health and Human Services Agency includes, “psychotherapy, continuous hormonal therapy, labratory testing to monitor hormone therapy and gender reassignment surgery that is not cosmetic in nature.” Within this definition, uterine transplants to aid gender dysphoria should be made more accessible through government-funded programs like Medicaid in states like Colorado, California, Connecticut, Delaware etc. If these services are not provided through federal funding, this highlights the broader issue of a lack of bodily autonomy for people of color, those below the poverty line, and LGBTQ+ members.  

Overall, uterine transplants present unmatched opportunity for transgender or infertile women to participate in expansive fertility options. However, the inaccessibility of these technologies consistently put women of color or those in poverty at a disadvantage when taking control of their reproductive autonomy. Uterine transplants are just one example of modern biomedicine highlighting social inequity. This can beg the question if novel assistive technologies perpetuate modern day eugenics by encouraging white reproductive choice, whilst alienating the conception of Black, LatinX or Native children.             

References

Healthcare Laws and Policies: Medicaid Coverage for Transition-Related Care. 10 Dec. 2021, https://www.lgbtmap.org/img/maps/citations-medicaid.pdf.

Hysterectomy - Why it’s necessary  - NHS. (2019, February 9). NHS. https://www.nhs.uk/conditions/hysterectomy/why-its-done/

Immunotherapy Side Effects - Cancer Research Institute (CRI). (n.d.). Cancer Research Institute. Retrieved March 13, 2022, from https://www.cancerresearch.org/en-us/immunotherapy-side-effects

Penn Uterus Transplant Program. (n.d.). Penn Medicine. Retrieved March 13, 2022, from https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/penn-fertility-care/uterus-transplant 

Perceptions and Motivations for Uterus Transplant in Transgender Women | Pediatrics | JAMA Network Open | JAMA Network. (2021, January 20). JAMA Network | Home of JAMA and the Specialty Journals of the American Medical Association; JAMA Network. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2775302

Ross, L., & Solinger, R. (2017). Reproductive Justice. Univ of California Press.

Sahakian, V. (n.d.). The Cost of IVF in California. Pacific Fertility Center of Los Angeles | Top-Rated IVF Clinic. Retrieved March 13, 2022, from https://www.pfcla.com/blog/ivf-costs-california

The Basic Facts About Women in Poverty - Center for American Progress. (n.d.). Center for American Progress; https://www.facebook.com/americanprogress. Retrieved March 13, 2022, from https://www.americanprogress.org/article/basic-facts-women-poverty/

Threadcraft, S. (2016). Intimate Justice: The Black Female Body and the Body Politic. Oxford University Press.

Uterus Transplant | Baylor Scott & White Health. (n.d.). Welcome to Baylor Scott & White Health. Retrieved March 13, 2022, from https://www.bswhealth.com/uterus-transplant/

Embryonic Selection of Genes Associated with Intelligence: A Dangerous Parallel To Eugenics

In the early twentieth century, racism, ableism, and social Darwinism found an abhorrent intersection in the practice of eugenics. Eugenics was a scientific movement to “improve” the human genome through horrific methods such as euthanasia and forced sterilization [1]. In Nazi Germany, these practices were used as a tool of the Holocaust. In the United States, they were used against marginalized groups such as those with disabilities or people of color [1]. These practices were based not only on the terrible devaluation of human lives, but also the incorrect belief that all human characteristics were easily attributed to genetics [1]. This “science” was claimed to be the justification for eugenics. The quantification of this was often through IQ tests, which eugenicists used to claim “feeblemindedness” if the scores were low enough [2]. Thus, using genetics to select against lower IQ scores was one of the facilitators of an incredible injustice – one that is, unfortunately, newly pervasive in the ever-growing field of genetic engineering. 

Today’s era of biotechnology poses an eerily familiar ethical dilemma. It has been almost twenty years since we first sequenced the entire human genome [3]. We know countless associations between genes and disease. And, to some extent, we can predict the chances of outcomes for embryos based on these associations [4]. The subjects of these genomic predictions range from health to intelligence, although the predictive power is far from one hundred percent [4]. Nevertheless, some companies have already begun to use these predictions for in vitro fertilization (IVF) through embryo selection based on polygenic scores, or ESPS [4]. But assigning value to certain traits over others – such as intelligence – and then proceeding to artificially select for them begins to sound analogous to a very dark part of our nation’s history.

ESPS is a new, underdeveloped technology, and has had several concerns surrounding both its biological and ethical consequences. These concerns were brought up in a study recently published in the New England Journal of Medicine. The study, “Problems with Using Polygenic Scores to Select Embryos,” claims that selecting against one gene could have inadvertent, deleterious repercussions on many other traits [4]. Conversely, in selecting for one trait, scientists might also unwittingly select for unfavorable ones [5]. This study also points out that much of the research for ESPS has been done on the genetics of adults with European ancestry, meaning that the predictive power will be far lower for anyone who doesn’t fit that description [4].

ESPS does have some beneficial purposes, as do many ethically-charged biotechnologies. For instance, it can help screen against Tay-Sachs Disease [4], which is an incurable disorder that leads to fatality around age five [6]. Yet, the aforementioned article published by the New England Journal of Medicine says that even “ethically appropriate” selection (against traits associated with mortality, for example) brings into question issues of unequal access. The article claims that even this “would probably exacerbate existing disparities in health owing to factors such as economic inequality [and] racism,” [4]. However, it is a different matter in instances of terminal illness that have been empirically proven to be linked with a specific genetic mutation, such as Tay-Sachs Disease. This is certainly a fine line on which to ethically balance. But, in avoiding the use of this technology, would we really condemn a child to death on the basis of the previous argument? 

Nonetheless, ESPS has developed outside of being used as a determinant for fatal genetic disorders. In particular, Steve Hsu, founder of the company Genomic Prediction, is a proponent of selecting against intellectual disability, which is associated with low IQ scores [7]. He argues that of the embryos created during IVF, the majority will be selected against anyway, based on something as simple as the embryo’s shape – so why leave this selection partially up to chance [7]? Why should parents not want to lower the likelihood of disease for their child? This is arguably ethical for cases of serious illness. However, selective reproduction based on something like IQ scores is essentially comparable to eugenics. Furthermore, it is well established today that IQ tests are poor markers of intelligence anyway because of their inherently complex, biased nature [2]. Yet the most important concept to consider is that intelligence, regardless of how measurable, is hardly a determinant of one’s quality of life [7]. Selecting against intellectual disability reinforces an idea that disability rights activists have been fighting for decades: that traits which lead to disabilities are somehow “less valuable” than others – that the life of someone with a disability will be less valuable than others [8]. 

Eugenics constitutes a dark time in the history of biomedicine. As our society moves away from this period into one of biomedical beneficence, we are obligated to pay special attention to anything that is reminiscent of this past. And while Genomic Prediction seems to have yet to provide this kind of intelligence reporting as a service on their website, we must be extra cautious in navigating this technology which intersects so dangerously with the tragic history of eugenics.

References 

1. National Human Genome Research Institute. (2021, December 1). Eugenics and scientific racism. Retrieved March 4, 2022, from https://www.genome.gov/about-genomics/fact-sheets/Eugenics-and-Scientific-Racism

2. Martschenko, D. (2017, October 11). IQ tests have a dark, controversial history - but they're finally being used for good. Business Insider. Retrieved March 4, 2022, from https://www.businessinsider.com/iq-tests-dark-history-finally-being-used-for-good-2017- 10 

3. National Human Genome Research Institute. (2020, December 22). The Human Genome Project. Retrieved March 4, 2022, from https://www.genome.gov/human-genome-project

4. Turley, P., Meyer, M.N., Wang, N., Cesarini, D., Hammonds, E., Martin, A.R., Neale, B.M., Rehm, H.L., Wilkins-Haug, L., Benjamin, D.J., Hyman, S., Laibson, D., Visscher, P.M. (2021, July 1). Problems with using polygenic scores to select embryos. New England Journal of Medicine; 385 (1), 78. Retrieved March 4, 2022 from DOI: 10.1056/NEJMsr2105065 

5. University of Southern California. (2021, June 30). Report sounds alarm on efficacy, safety, ethics of embryo selection with polygenic scores: A multinational team of researchers describes the limitations and risks of the new service. ScienceDaily. Retrieved March 4, 2022 from www.sciencedaily.com/releases/2021/06/210630173622.htm 

6. National Organization for Rare Disorders, Inc. (2021). Tay sachs disease. Retrieved March 4, 2022 from https://rarediseases.org/rare-diseases/tay-sachs-disease/

7. Adler, S., Cusick, R., & Walters, P. (2019, July 25). G: Unnatural Selection | Radiolab. WNYC Studios. Retrieved March 4, 2022 from https://www.wnycstudios.org/podcasts/radiolab/articles/g-unnatural-selection

8. Ouellette, A. (2011). The Struggle: Disability Rights versus Bioethics. In Bioethics and Disability: Toward a Disability-Conscious Bioethics (Cambridge Disability Law and Policy Series, pp. 12-46). Cambridge: Cambridge University Press. Retrieved March 4, 2022 from doi:10.1017/CBO9780511978463.003

In-Vitro Gametogenesis Opens New Doors for Same-Sex & Infertile, Hopeful Parents

For same-sex or infertile couples looking to have a child, there are several options; adoption, surrogacy, and in-vitro fertilization (IVF) have come a long way since their origins. However, there is one possibility that scientists hope to develop—the ability for these types of couples to conceive biological children. The most promising method is in-vitro gametogenesis (IVG). Both IVF and IVG are the implantation of an embryo fertilized in vitro (meaning outside the body) into a womb. However, unlike IVF, IVG is the creation of sperm or egg cells from adult somatic cells, rather than the use of pre-existing gametic cells. With IVG technology ethical concerns have arisen, many of which are similar to those surrounding IVF when it was first developed. 

The event that spurred this on was a discovery in 2006 by scientist Shinya Yamanaka. Yamanaka was able to create induced pluripotent stem cells (iPSC) from the adult somatic cells of mice. Pluripotency is the ability of a cell to change into any type of cell. In nature, once a cell develops into, for example, a muscle cell, it is unable to change into another cell type. The only cells that can naturally differentiate into multiple types of cells are stem cells. [1] The development of iPS cells is so important because, before this discovery, to work with human stem cells, a scientist would have to extract them from human embryos. iPSC offers a close imitation of embryonic stem cells without any need for an actual embryo. The creation of iPS cells not only changed the future of fertility but other fields such as organ transplantation and drug development. 

This may sound like the perfect solution, but it is not so simple. One main issue is that it is more difficult to have an iPS cell develop into an egg than other cell types. From MIT Technology Review, “Certain cell types are very easy to make in the lab: leave pluripotent stem cells in a dish for a few days, and some will spontaneously start to beat like heart muscle. Others will become fat cells. But an egg might be the hardest cell to produce. It’s huge—one of the largest cells in the body. And its biology is unique, too. A woman is born with her full complement of eggs and never makes any more.” [2] However, there is hope for the future. Per Professor Sonia M. Suter of George Washington University Law School, “So far scientists have not achieved similar success in creating human oocytes, although they have derived egg-like cells. Given that research on mice has yielded both sperm and oocytes, however, it is probably merely a matter of time before human oocytes can be derived in vitro.” [3]

The other major issue when utilizing IVG for same-sex couples is the issue of X and Y chromosomes. For two biological females to have a biological child together, a cell from one female would need to be changed into a sperm cell with an X and a Y chromosome. Similarly, for two biological males to have a biological child together, one of their cells would need to be changed into an egg cell with two X chromosomes. The male couple would also need to have someone else with a womb carry the child until its birth. [4] The matter of X and Y chromosomes, however, is not an issue for opposite-sex infertile couples. 

There are a variety of difficulties making scientists hesitant about pursuing in vitro gametogenesis. Firstly, we must address one significant problem: the stigma surrounding same-sex couples having children together. Same-sex couples in many countries are still unable to marry or have joint custody of children. Only 33 countries recognize joint same-sex adoption, which is only 17% of the world’s nations. [5] As many places do not allow same-sex adoption, even if IVG advances it is possible that same-sex couples will not be able to use it. Prejudice towards same-sex couples is stinting the study of this form of childbearing, as funding for scientific research is allocated towards what is seen as most beneficial for a country’s citizens, and thus the majority of countries will not allocate funding for this type of research. However, as IVG would also help infertile heterosexual couples, and as sentiment towards same-sex couples generally improves, hopefully this is a problem that will become less glaring in the future. 

Another issue is how we approach the research of IVG. The fear is that in order to pursue the research of IVG for commercial use, we will have to create and destroy artificial embryos. This is an ethical issue for many scientists and researchers. Additionally, research into IVG would likely further the genetic editing field as a whole, and many may ask: if we are creating embryos artificially and can edit them, why not make our children the best they can possibly be? This leads to the slippery slope of ‘designer babies’ and eugenics. Professor Sonia M. Suter writes, “Given the breadth of genetic information that would potentially be available with such technological advances, future parents would have the potential to select embryos or gametes not only based on genetic factors associated with illness, but also based on certain traits. This development might motivate ever more fine-tuning of the ‘quality’ of future offspring and potentially normalize the kinds of commodification attitudes that are troublesome under relational autonomy.” [3] Many are very worried about the future of genetically edited embryos because it can further strengthen disparities based on wealth, class, and access to cutting-edge medical technology. If only the top echelon of humanity can afford or access this technology, this can widen the divide between them and the rest of the population. However, this concern is not unique to IVG. It has been voiced about nearly every other genetic innovation, from CRISPR to IVF. This technology will not inherently lead to negative outcomes: it is all about how it is used and how lawmakers regulate it. 

Despite all these potential worries surrounding IVG, its development would truly change lives. The ability for infertile and same-sex couples to have biological children seems like science fiction, but it may be within our grasp. As long as IVG, similarly to many other scientific innovations, is developed, used, and regulated responsibly, this technology could truly change the ability of many families to grow.  

References:

1. Pontin, J. (2018, March 27). Science Is Getting Us Closer to the End of Infertility. Wired. https://www.wired.com/story/reverse-infertility/

2. Regalado, A. (2021, October 28). How Silicon Valley hatched a plan to turn blood into human eggs. MIT Technology Review. https://www.technologyreview.com/2021/10/28/1038172/conception-eggs-reproduction-vitro-gametogenesis/

3. Suter S. M. (2015). In vitro gametogenesis: just another way to have a baby? Journal of law and the biosciences, 3(1), 87–119. https://doi.org/10.1093/jlb/lsv057

4. Lehmann-Haupt, R. (2018, February 28). Get Ready for Same-Sex Reproduction. NEO.LIFE. https://neo.life/2018/02/get-ready-for-same-sex-reproduction/

5. Which countries allow adoption by same-sex couples? (n.d.). CoParents.Co.Uk. https://www.coparents.co.uk/blog/which-countries-allow-adoption-by-same-sex-couples/

Do Plants Have Rights?

Like most questions in the field of ethics, whether or not plants have rights is a complicated question with a not-so-straightforward answer. It entails having to establish the moral obligations, if any, that humans may have toward plants; to do that, we must define what rights are in the context of scientific research. 

Research has a long history, with clinical research dating as far back as 500 BC [1]. All good research requires experimentation and, thus, experimental subjects. When it comes to clinical research, where the primary goal is understanding the mechanisms of the human body, humans are the ideal experimental subjects. The Hippocratic Oath defined a physician’s duty as limiting the harm inflicted upon patients, but a researcher is not a physician, and such protections didn't apply to human experimentation practices. In the modern age, there are many rules, regulations, and committees dedicated to protecting the lives, privacy, and freedom of human research subjects because violating these rules would be a violation to humanity’s moral values [1]. These moral values are the foundations of human rights in the context of research. 

Humanity’s moral obligations also extend to animals, though not to the same extent as human rights. The use of animals as experimental subjects has numerous regulations, which is a result of public outcry against the cruel treatment of animals in research [7]. One of the main reasons for protecting animals is the argument of sentience. According to the Merriam-Webster Dictionary, sentience is defined as “responsive to or conscious of sense impression”; in other words, an entity must be able to act upon and be aware of its own emotions. There have been numerous studies on animal psychology, and it has been found that animals are capable of experiencing suffering [6]. Animals move and eat, and many have complex social behaviors. In this way, animals are naturally perceived as being alive .

The same reasonings often used to justify the need for animal rights, unfortunately, either don’t apply to plants or are highly contested. For example, do plants even have emotions for them to act upon? Plants might share many similarities to humans and animals on a cellular and micro scale, but looking at the macroscale, plants don’t move or eat (excluding the carnivorous plants) or vocalize or possess a brain. They just exist and grow and wait to be eaten by herbivores and omnivores. Those in support of plant sentience cite that plants are capable of chemical communication when in danger and some are even responsive to music or scents [5]. 

So, plants do have rights?

Perhaps this is enough to justify plant sentience, and, therefore, the validity of plant rights. There is, however, the subsequent issue of what those rights are and how they should be enforced. This is an issue that also plagues the debate with animal rights. Animals are traditionally regarded to be lower on the priority scale compared to humans; after all, animals have been a source of food and labor for much of human history [7]. Even so, at the very least, regulations can be set in place to ensure that animal testing is not cruel and inflict undue suffering, and people can choose to remove meat from their diet. Enforcing similar regulations on plants would pose contradictions to human morality. Plants have a plethora of uses, from making dyes to being nutritious foods. Many of these uses involve “killing” the plant. Unlike meat, plants cannot be removed from the human diet; there’s a lot of nutrients contained in plants that humans cannot make themselves. Plants also have no use for privacy, and it’s quite difficult to get their consent. 

If there isn’t anything for the law to enforce, then, even if humans possess moral obligation to plants, plants may as well not have any rights at all.

The only way for plants to receive any form of rights would be to not view them as individual entities but as a whole. Around the world, there have been instances in which people have assembled together to call for the protection of an ecosystem by way of granting that ecosystem legal rights [3].

The Amazon rainforest is one of the largest rainforests in the world, home to a diverse abundance of fauna and flora. As human civilization has continued to grow, requiring more land and resources, the Amazon has experienced many destructive changes in recent decades. In response to these changes, a group of young Colombians filed a lawsuit in 2018 against the Colombian government for depriving its citizens of the right to live in a healthy environment and future. The plaintiffs won the case, and the region of the Amazon within Colombian borders is now protected under the same rights as any human being [2]. 

In the United States, as a result of the people’s efforts to combat the increasingly worsening conditions the lake was facing as a result of pollution, Lake Erie also obtained legal rights. This decision was a stark contrast to the case of Sierra Club v. Morton in 1972, where the United States Supreme Court ruled that nature should not have legal rights [4]. It can be seen that times have changed, and the recent increased awareness of environmentalism has brought to public attention the need for protecting the world’s forests and ecosystems. 

The question of ethics and human morality has many layers and must be taken into consideration thoughtfully and carefully. Humans share a communal space with all of the living organisms on this Earth. Because of our tools and intelligence, we have been able to grow our civilizations and influence the world around us for better and for worse. The plants that grow outside should be able to grow and flourish and not be driven into extinction. As the human population continues to grow, we must be ever conscious of the consequences of our actions and acknowledge that our leafy neighbors have just as much right to live in this world as we do. Plant ethics, or rather, nature ethics may not currently be our most foremost priority, but it is plausible that given the state of our world and environment, this question will receive greater importance in the coming years. 

References

1. Bhatt A. (2010). Evolution of clinical research: a history before and beyond james lind. Perspectives in clinical research, 1(1), 6–10.

2. Moloney, A. (2018, April 6). Colombia's top court orders government to protect Amazon forest in landmark case. Reuters. Retrieved February 27, 2022, from https://www.reuters.com/article/us-colombia-deforestation-amazon/colombias-top-court-orders-government-to-protect-amazon-forest-in-landmark-case-idUSKCN1HD21Y 

3. Samuel, S. (2019, April 4). Should animals, plants, and robots have the same rights as you? Vox. Retrieved February 27, 2022, from https://www.vox.com/future-perfect/2019/4/4/18285986/robot-animal-nature-expanding-moral-circle-peter-singer 

4. Samuel, S. (2019, February 26). Lake Erie now has legal rights, just like you. Vox. Retrieved February 27, 2022, from https://www.vox.com/future-perfect/2019/2/26/18241904/lake-erie-legal-rights-personhood-nature-environment-toledo-ohio 

5. Weeks, L. (2012, October 26). Recognizing The Right of Plants to Evolve. NPR. Retrieved February 27, 2022, from https://www.npr.org/2012/10/26/160940869/recognizing-the-right-of-plants-to-evolve 

6. Psychology and Counseling News. (2019, October 22). Do Animals Have Feelings? Examining Empathy In Animals. UWA Online. Retrieved February 27, 2022, from https://online.uwa.edu/news/empathy-in-animals/#:~:text=Still%2C%20most%20scientists%20agree%20that,feelings%20much%20like%20we%20do. 

7. "What Are the Issues Surrounding "Animal Rights"?." Institute of Medicine. 1991. Science, Medicine, and Animals. Washington, DC: The National Academies Press. doi: 10.17226/10089.