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It shows all of the elements of each part of the spectrum considered with regard to surrogacy. Examples include not treating the surrogate as a legal mother although insisting on a close relative acting as one; requiring prebirth consent and surrendering of all rights pre-conception, which is an approach usually taken only by jurisdictions allowing commercial surrogacy; not providing for the inviolable rights of the surrogate, as is usually done in all altruistic regimes; insisting that she take on the burden of altruism while the doctors get paid but also be subjected to a legally enforceable contract which has no provision for withdrawal. Enforceability of the surrogate contract is actually a familiar element of countries that allow commercial gestational surrogacy. In this manner, the 2019 Bill strikes discordant notes between its objectives, strategy and elements. Regulatory Legitimacy Roger Brownsword wrote of the importance of maintaining legitimacy while legislating in the 126 face of scientific and technological change. He argued in his seminal work on the subject that regulators must be able to support a legitimate regulatory purpose for their regulatory strategies, that they are achieved through legitimate means, and that they are effective. In case of the surrogate mother or a potential surrogate mother (the identified subject for our analysis), we find the particular need to safeguard her from communicative vulnerability, deferential vulnerability, economic vulnerability and social vulnerability. Which identified Communicative Vulnerability this type of vulnerability is vulnerability creates directly identifiable with the surrogacy arrangement in which a inequality in law for surrogate is unable to communicate her concerns effectively or the subjectfi Which identified Social Vulnerability Social vulnerability recognizes the vulnerability results vulnerability of participants who are at risk of discrimination in discrimination on account of race, gender, ethnicity and age. For example, doctors may treat surrogates as technology rather than patients and therefore not give them the same degree of care as a patient would get. If it impedes Spousal consent has been made mandatory in surrogacy 277 Chapter 8 freedom, then is the arrangements. However, it is not mandatory in abortion, and restriction reasonable the Supreme Court has frowned on a high court that had and has the subject impleaded the husband and father of a woman seeking been adequately permission for abortion, stating that the required consent is 128 consulted about this only from the woman herself. The question the regulator poses then is the reasonableness of this, and has the surrogate been adequately consultedfi Is making them a mandate of doctors and intending parents for their convenience reasonable for the surrogatefi Which identified Economic Vulnerability Economic vulnerability in surrogacy vulnerability requires specific caution in the recruitment of surrogates. It is threatens the right to important that the payment offered does not encourage an life and liberty of the individual to put herself at greater risk than they would subjectfi Which identified Economic Vulnerability or deferential vulnerability, in which vulnerability may the surrogate is forced to provide her labour or is put under result in an absolute compulsion to her detriment. Is there a way in Close monitoring of the economic element of the transaction which the absolute and the deferential relationships the surrogate may be bound possibility of by and also making sure the transaction cannot be forced upon exploitation can be the surrogate, may be ways to reduce the possibility of reduced for the exploitation. If the answer to 7 is Here, for example, if the regulator were to prefer prohibition no or if prohibition is of commerce in the surrogacy arrangement, the next step preferred by would be to assess if such prohibition would be affected by regulators, then other fundamental rights. For example, if it were confirmed would such that making a surrogate perform her part in a surrogacy prohibition of the act arrangement without remuneration would amount to which creates an constrained labour that would be constitutionally unsound absolute possibility of under Article 23, the regulator would need to reconsider using exploitation impinge a negative channelling. With these answers, the regulator can now adopt the most preferable regulatory pitch and range, which avoids being constitutionally unsound and also ameliorates the various kinds of vulnerabilities identified for the subject. The regulator can also consider different strategies if the industry to be regulated is already in operation, with due consideration to what phase it is 279 Chapter 8 in. Based on this, the ideal mix of elements that would take forward the objective of the proposed law can be effectively identified. Going through the elements one by one against the Vulnerability Construct and the Constitutional Lens, the following is found: 1. Recognizably, the surrogate is structurally subordinate in the surrogacy arrangement. In order to enhance her position to one of strength, she has to be allowed to be as autonomous as possible.

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Attention to such sensations, especially if linked to an unpleasant emotion, may occasion the experience of pain. Noticing the sensation results in fear, and the distress of this emotion is perceived as pain. This would appear to be the explanation for the vital feelings of depression described in Chapter 16. Vital feelings are the localization of depression in a bodily organ, complained of, perhaps as pain, in the head or chest or elsewhere. On further questioning, symptoms are described as being unpleasant, painful pressure or even a feeling of misery and depression in that organ: morbid interpretations of ordinary bodily sensations. With disorder of affect, the sensation may be morbidly interpreted as being due to cancer, tuberculosis or venereal disease. There are, of course, also actual physical changes in depression, for example slowing of peristalsis and decreased gastrointestinal secretions, and these may also provoke unpleasant sensations such as spasm and constipation. Central pain (thalamic syndrome) is experienced as a spontaneous burning sensation that can be activated by cutaneous stimulation or temperature changes. It is usually intractable and occurs in the setting of cerebrovascular accident, multiple sclerosis, syringomyelia and spinal cord injury. Diminished Pain Sensation and Pain Craving In certain situations, there is a decrease in the perception of pain. Pain asymbolia is a condition in which situations that should give rise to pain do not (Schilder and Stengel, 1931). There are at present fve recognized hereditary varieties, usually associated with autonomic neuropathies including anhidrosis (Butler et al. In patients with schizophrenia and their relatives, there is evidence of elevated pain thresholds and pain tolerance demonstrated by relative insensitivity to fnger pressure (Hooley and Delgado, 2001). In other situations, such as acute drunkenness, there is diminished appreciation due to the central depressant action of alcohol, and opiates similarly are analgesic through their action on the central appreciation of pain. Excitement or aggression, as in footballers or soldiers, may render the subject oblivious to serious injury. When a wound has advantages to the patient, for example enabling a soldier to leave the battlefeld, it causes less pain than when the injury is seen as wholly disadvantageous. Various psychological techniques can reduce the experience of pain, including hypnosis, various stratagems in childbirth, placebo medication and, possibly, acupuncture. The patient may bang his head so that there is chronic haematoma formation, bite himself or otherwise harm himself repeatedly, causing permanent damage. These patients are usually female (Graff and Mallin, 1967), and the behaviour appears to be linked with the desire to relieve tension and alleviate negative emotions.

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A radiologic technician should be available 24 hours per day to perform portable X-rays. Availability of a postpartum care provider with expertise in lactation is essential. The need for other support personnel depends on the intensity and level of sophistication of the other support services provided. An organized plan of action that includes personnel and equipment should be established for identification and immediate resuscitation of neonates in need of intervention (see also Chapter 8 for information on neonatal resuscitation). Additional medical social workers are required when there is a high volume of medical or psychosocial activity. Education In-Service and Continuing Education the medical and nursing staff of any hospital providing perinatal care at any level should maintain knowledge about and competency in current maternal and neonatal care through joint in-service sessions. These sessions should cover the diagnosis and management of perinatal emergencies, as well as the management of routine problems and family-centered care. The staff of each unit should have regular multidisciplinary conferences at which patient care problems are presented and discussed. The staff of regional centers should be capable of assisting with the inservice programs of other hospitals in their region on a regular basis. Such assistance may include periodic visits to those hospitals as well as periodic review of the quality of patient care provided by those hospitals. The medical and nursing staff of hospitals that provide higher level care (ie, beyond basic and level I) 36 Guidelines for Perinatal Care should participate in formal courses or conferences. Responsibilities should include assessing educational needs; planning curricula; teaching, implementing, and evaluating the program; collecting and using perinatal data; providing patient follow-up information to referring community personnel; writing reports; and maintaining informative working relationships with community personnel and outreach team members. Other professionals (eg, a social worker, respiratory therapist, occupational and physical therapist, or nutritionist) also may be assigned to the team. Each member should be responsible for teaching, consulting with community professionals as needed, and maintaining communication with the program coordinator and other team members. Each subspecialty care center in a regionalized or integrated system may organize an education program that is tailored to meet the needs of the perinatal health professionals and institutions within the network. The various educational strategies that have been found to be effective include seminars, audiovisual and media programs, self-instruction booklets, and clinical practice rotations. Perinatal outreach education meetings should be held at a routine time and place to promote standardization and continuity of communication among community professionals and regional center personnel. As mandated by the subspecialty boards and the Accreditation Council for Graduate Medical Inpatient Perinatal Care ServicesCare of the Newborn 3737 Education, a facility providing subspecialty care that has a fellowship training program must have an active research program. Special facilities should be available when deviations from the norm require uninterrupted physiologic, biochemical, and clinical observation of patients throughout the perinatal period. Labor, delivery, and newborn care facilities should be located in proximity to each other. When these facilities are distant from each other, provisions should be made for appropriate transitional areas. The following recommendations are intended as general guidelines and should be interpreted with consideration given to local needs. Individual limitations of physical facilities for perinatal care may impede strict adherence to these recommendations. Provisions for individual units should be consistent with a regionalized perinatal care system and state and local public health regulations. The service should be consolidated in a designated area that is physically arranged to prohibit unrelated traffic through the service units.

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