Matthew Blurton, MD

• Radiology Department
• Singleton Associates, PA
• Houston, Texas

Swaraj (who headed the Group of Ministers (GoM) gastritis gagging order bentyl overnight, Union Cabinet that cleared the 2016 Bill) stated in her interaction with the media that the clinics and hostels will continue to remain in operation dr weil gastritis diet order generic bentyl. Swaraj further emphasized that the hostel and all medical expenses will be borne by the intending parents gastritis diet food list order bentyl 20mg with mastercard. Far from altruistic gastritis diet vs regular buy bentyl line, such an arrangement seems rife with profiteering intentions that deliberately exclude and marginalize the surrogate gastritis diet and exercise generic 20mg bentyl with visa. While the thrust of these Sections appears to be against organized profiteering from surrogacy and the exploitation of the surrogate gastritis upper back pain discount bentyl 20 mg without a prescription, the mention of the word person brings it down to the individual and may very well mean the surrogate herself who becomes an identified offender. This is a serious oversight and particularly susceptible to creating conditions where a surrogate (who may have accepted aid beyond the strict contours of an altruistic arrangement) is thereafter manipulated on account of this legal vulnerability. Surrogacy contracts have gained legal validity and enforceability due to the support of the Supreme Court of India. We have examined in an 55 independent article the exploitative nature of standard conditions that presuppose that a woman has acquired the consent of her husband, before choosing to act as a surrogate, in effect reducing her own agency as an adult individual. Our analysis of the 2016 Bill, however, reveals that without a robust account of the vulnerabilities of the surrogate, and a sole focus on material outcomes of the surrogacy arrangement, legislative practices fail to foster patterns of care and fair compensation for the surrogate mother, and fail to place her at the center of legislative consideration. C MacIntyre(n 15) 187 Chapter 6 by her own family members or medical practitioners, making her more susceptible to exploitation in deferential or institutional relationships. She may be conditioned to serve and be unable to articulate herself sufficiently or make herself heard [social vulnerability]. Her 58 requests for information may be denied on account of not being worthy of consideration. The visibilisation of relational vulnerability vis a vis a surrogate helps one understand her position at the intersections of her social and familial relations to illuminate her state of well being. This can also then be used to ascertain if she is further at risk of coercion or Figure 2 influence on account of deferential vulnerability. It is seen in our previous work on the vulnerability construct that surrogates empirically have exhibited enhanced deferential vulnerability i. This may mean that she has a sense of servitude and an inability to articulate herself as her own agent. This suggests a need that regulatory policies extend towards sensitive recruitment and consent plans where the surrogates have the space to consent voluntarily without feeling obligated or coerced into doing so. As seen in the preceding section, the very concept of a close relative acting as a surrogate has very little acceptance, and is unlikely to get recognition for fear of being further invisibilised to maintain the status quo. Moreover, the almost compulsory nature of her stay in a surrogacy hostel, as suggested in the press briefing, is troubling. The signed agreement is a way to ensure that she is unable to object to the 64 constant oversight, restrictions on her movement and clinical supervision. In India, 65 marriage does not need compulsory registration under law and marriages concluded in 66 traditional ceremonies or as per custom are recognized even when not registered. Such women act for a family as child bearers and carers, sex providers, domestic workers and 69 laborers and are then passed on to another family. Considering the inequity and disposability of matrimonial relationships, the risk that these functions may also come to include surrogacy is possible. We find it important that the payment offered does not become an inducement that encourages an 71 individual to assume more risk than they would in the absence of the payment. In this regard, the basis of the 2016 Bill is the conviction that the driving force for a surrogate mother to enter into a surrogate arrangement is money. It is this vulnerability, precipitated by economic need that the 2016 bill purports to eliminate, by making payable only those expenses that are incurred in the procedure. The proposed 2016 Bill allows payments to doctors, concerning medical expenses incurred on the surrogate, and hostel expenses for nine months, but no payments to the surrogate for her own expenses or contribution. It has been seen in the past that with the assurance of legality from the Supreme Court of India in less than a decade, the surrogacy industry in India became a multimillion-dollar industry. This is due to the huge medical and pharmacological dependence of a surrogacy arrangement in achieving successful births. By retaining payment of medical expenses, the Government of India privileges 68 ibid. The rigors of legal enforceability the right to bodily integrity is at the very core of personal freedom and naturally flows from the right to life under Article 21 of the Constitution of India, which includes the right to live with 72 dignity. While the 2016 Bill provides for the requirement of consent, it does not equally make provisions to protect certain inalienable rights such as the right to privacy, bodily integrity or reproductive freedom; nor does it include within it the scope of withdrawing consent. The freedom of giving of consent must also include within it the scope for withdrawing of consent. This observation, made by the Delhi High Court on the rationale that the commissioning mother remains the legal mother of the child both during and after the pregnancy, is one instance of many where the rights of the surrogate are annulled by practices that assume that the genetic material within the body of a surrogate mother is the property of the intending parents. The 2016 Bill does nothing to change this and may in fact have dire consequences for the surrogate mother. In the Sama study, researchers have documented that in virtually all cases, the surrogate is not informed about multiple implantations, possibility of 79 multiple births, fetal reduction, abortion, organ strain, and risk of premature birth. The choice regarding abortion, whether for health or convenience purposes, belongs to the contracting 80 parents. In such situations, the surrogate may not only be deprived of a right to her own bodily integrity but also to rights all other medical patients have, such as the rights to consider an alternative medical opinion, to undertake or refuse surgery, or to seek medical termination of pregnancy in accordance with Indian law. The constitutional backing to such enforceability, particularly upon the surrogate, is unclear. One is specific performance, which means compelling the defaulting party to perform her contractual undertakings. The other is to award damages, which involves a monetary payment by the defaulting party. Until August 2018, specific performance of a contract was a remedy that courts had the discretion to grant, only as an exception when monetary compensation would not be adequate relief for the non-performance of contract. The Specific Relief (Amendment) Act, 2018, however, now makes it mandatory for a court to grant specific performance of a contract. However this may well be the unintended consequence in a surrogacy arrangement that is based on a legally enforceable contract as the 2016 Bill is seeking to do. Still, upon withdrawal of consent during the contract, the surrogate cannot, like any other contractor, walk out of the workplace since she is the workplace. It is for this reason that termination of pregnancy is only permitted when the conditions specified in the applicable statute i. This may raise doubts about the very constitutionality of such a contract particularly when the surrogate herself is not benefiting from it in any manner. However, it is unclear in the circumstances if the prohibition of Article 87 23 can apply to a surrogacy arrangement, which a statute has declared as legally enforceable (as would be the case if the 2016 Bill were to become the law on the subject). It appears that this order may be passed even before conception making the surrogacy arrangement enforceable in law at a nascent stage and one from which the surrogate is unable to resile. The familial bonds emphasized by the altruistic arrangement are at odds with a legally enforceable mandatory contractual arrangement. The morality of a legally enforceable contract in surrogacy is questionable, particularly one that cannot be withdrawn from given the nature of the transaction. That the same is to take place within the four walls of family or that of a surrogacy hostel, renders invisible an arrangement that could well be the breeding ground for domestic violence and exploitation. This suggests that the 2016 Bill may bring about a position of even greater vulnerability for a surrogate mother. It is also seen that in contrast to the previous regimes that allowed commercial surrogacy, the 2016 Bill now prohibits it. However it continues to treat the surrogacy arrangement as a contract, while making no provision for withdrawal, treating the same as legally enforceable against the surrogate mother. Where regulation is in its first phase, its purpose is to control, confine and channel ex ante the 89 particular aspect of practice that is its target. Secondphase regulation on the other hand operates ex post, endeavoring to compensate for, or adjust to the consequences of a practice that cannot be controlled by first-phase regulation. Merely because there may be some instances of exploitation, does not justify a regulatory reaction that amounts to throwing the baby out with the bathwater. Every country makes murder a crime and attaches severe penalties to it, yet it occurs nonetheless. The fact that it does has never been a reason 90 for giving up on the law or any attempts to enforce it. The regulatory position being imposed is obviously not synced to ground realties and thus has a much greater chance of failure. Commentators have shared their concern on this stating, Today, when surrogate mothers have legal rights, there are accusations of exploitation. Then these poor women would have no legal rights and the chances for 92 exploitation would be even more. With a high risk of surrogacy trafficking for even small sums of money, the surrogate mother may come to be hidden in plain sight in an arrangement in which her lack of agency is palpable. As she has no immunity under the proposed 2016 Bill and may herself be treated as an offender, there is little encouragement for her to come forward even if she were to face exploitation, for fear of criminal prosecution. To move beyond this legal impasse, we need an ethics of vulnerability that might open the possibility to understand the position of the surrogate better and proceed to respond to her needs in law and policy in ethically defensible ways.

Ainsley reflected positively about the vaccine gastritis diet ùä÷ bentyl 20mg with visa, particularly after the first and second injections as she then knew what to expect and had time to see that nothing negative or adverse had happened to her thus previous fears had been allayed gastritis ginger cheap bentyl 20 mg. Despite this eosinophilic gastritis elimination diet generic bentyl 20 mg with mastercard, the images she drew throughout the diary would focus on the needle and blood gastritis skin symptoms bentyl 20 mg with visa. Ainsley has used feathers decoratively in Figure 27 but it is unclear why Ainsley has used the feathers here gastritis diet ïîãîäà order cheap bentyl on line. In the front cover of her diary Emily has stuck a black and white photograph of herself from 2007 and has apologised gastritis diet òàíöû order bentyl 20 mg without a prescription, in writing next to it, for not having a more recent photo. At the end of the text in which she describes her horse, Emily signs the page with her name and a heart sticker. This is suggestive of her completing the diary at my request; she is purposely signing off as you would a letter or note to a known recipient. Emily often spoke of her poor attendance record at school and she seemed to lack any great investment in academic achievements or additional school activities. She also repeated some of the tasks, particularly on the day when we met for her to return her completed diary to me. Some of this confusion over which tasks she had completed could be down to her having moved house during the period of the diary work. In keeping with her scattered style of entries there are two written entries about the hall. Twelve pages on from the first description (Figure 29) is a drawing of the hall and over the page is the scribbled out hall description. There are pink dashes to the right of the black line (representing the blue screen) at the top of the hall and in the first four rows of chairs. At the end of the written description for this task Emily has again signified that she is writing the diary for me. I read this as a concern that Emily wanted to perform well for me and my research project. She has drawn round the star in various colours to outline it and on the rest of the page she has drawn pink and purple hearts. Emily has simply used red pen and pencil to create this diary entry which may be indicative of the straightforward way in which she views the needle; something that has to be done and which does not have any additional niceties related to it through the use of colours, stickers, ribbons etc. At the bottom of the page is a smiley face she has drawn with a wide mouth possibly representing shock or being scared. In this task Emily does not relate the answer or the situation to me as her audience. Emily directly references me or uses my name five times in her diary and she also stuck in two of the notes I have sent her in the post; the first is a checklist of tasks which she asked me to send her and the second is a note I sent when I was sending her a folder, that the young women had requested, to keep all their materials in. But this is maybe not so easily the case when I consider this alongside the level of self-investment and direction Emily has displayed in order to add to her diary. I find the juxtaposition of these both intriguing and indicative of the world outside of the vaccine diaries. I prompted the young women twice to decorate the diary and make it about themselves; once at the start of the project and once during the half term. Practicing their versions of young woman in response to the vaccine follows from the assertions above regarding the parameters within which they are able to form their identity. Often when differences are experienced in relation to a medical intervention, these are put down to the individual rather than the intervention 136 affecting people differently. This prioritises medical adverse effects as opposed to social and emotional trauma experienced by the young women. The vaccination has been easily integrated and subsumed in the lives of these young women. The negativity experienced was short-lived and tangential to the other concerns and things going on in their lives. She has placed smiley face stickers around the star and has spelt her name and age in alphabet and numbered stickers beneath it. Perhaps quite obviously by the choice of name and school name, Beth is a fan of both Dr. Beth became involved in this project through a chance discussion I had with her mother Suzzanne at a conference (detailed earlier). Beth asked me to change the name of her favourite band from the one that originally appeared on the cover of her diary to the one which is now written above; Fall Out Boy. This could be demonstrative of the fact she attends a different school, but I feel it is more reflective of the approach her 138 parents have to discussing issues with Beth and providing information and rationale for not vaccinating. Such rationale and justification is something that is not required if the parental decision reflects the norm of accepting. In addition to sending Beth diary tasks via text message, I also met with her on three occasions detailed earlier. During the audio-recorded research conversation with Beth and Suzzanne she reflects upon her position as being different. It was towards the end of the research conversation, once she and Suzzanne had developed a rapport and a more trusting environment with me that I asked specifically about whether Beth felt different having not had vaccines in the past, being a non-Muslim and having two mams and a dad. A clear distinction, other than vaccine acceptance/decline, between her and Ainsley and Lexi is their thoughts on the boy band One Direction! The term refuser suggests a problematic position to hold, with a decidedly pejorative quality to the label. In the text above this Beth has described the three different vaccination administration days. This additional measure, which is carried out by the nursing staff in order to check whether a young woman is having the vaccine or not, is of interest. This additional measure is not carried out to ensure that the consent given is indeed the true wishes of the parent or carer. This is likely because the act of signing and returning a consent form is seen as an active choice from an invested adult. In the materials provided to me by Mary, the School Health advisor states that clinical staff will telephone the parents or carer if consent forms have not been returned. By prompting the young women to include personal interests and information about themselves, be that through the decoration on the diaries or the questions about their activities during school holidays, the diaries provide a space for the articulation of a broader self, a fuller picture of these young women than the health intervention makes visible. This broader self is of significant interest to my professional commitments of creating a space for the young women to engage in meaning-making of their worlds.

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Syndromes

• Increased size of the clitoris
• Practice proper skin care to avoid bedsores and skin infections.
• Immunotherapy, which gives you a shot of a substance that causes an allergic reaction and helps the wart go away
• Toxins and poisons
• Hyperaldosteronism
• Fainting