The health and economic benefits of breastfeeding are well documented, and mothers' milk is considered the optimal feeding method for almost all infants. 1-4 Reports of benefits for breastfed infants and children include decreases in otitis media, 5-7 atopic dermatitis, 8 and gastroenteritis, 9 -11 as well as a lower risk of obesity 12,13 and asthma. 14 -17 Additional benefits include a reduced incidence of sudden infant death syndrome, 18,19 type 1 and type 2 diabetes mellitus, 20 -23 and childhood leukemia. 24,25 In addition, there are maternal health benefits of breastfeeding that include reduction in the risk of breast cancer, 26,27 ovarian cancer, 28 -31 type 2 diabetes mellitus, 32 and an association between not breastfeeding and postpartum depression. [33][34][35] Given this evidence, health care providers should take an assertive stance in promoting, protecting, and recommending breastfeeding to expectant and new mothers. This is consistent with current professional policy statements 1-4 on breastfeeding and the use of human milk. This commentary discusses the ethical obligation for provider encouragement of breastfeeding, given the state of the science regarding the health benefits of breastfeeding. MOTHERS' NEEDS FOR INFORMATIONMothers often present to the clinical setting without enough information to make an informed decision about infant feeding. They often lack knowledge about the differences between feeding methods or how to go about learning the skill of breastfeeding, 36 and look to health care providers for this information. 37,38 Studies 36,39 report that women who chose formula feeding knew that human milk was "best" but felt that formula was "adequate." In one study of mothers of preterm infants, 36 the participants reported not knowing that there was a difference between formula and breast milk and appreciated being given this information. Because health care providers offered evidence about these differences, all participants in this study changed their initial decision from formula feeding and provided their own milk to their infants for a minimum period of 30 days after birth. Mothers also expressed the opinion that health care providers who told them that breast milk and formula were the same had failed to do their job. This study illustrates how mothers depend on health care providers for knowledge and information about the differences between human milk and formula feedings, and the relationship of infant feeding method to health outcomes. FACTORS THAT AFFECT THE MATERNAL DECISION TO BREASTFEEDStudies of maternal choice about infant feeding methods 40 -52 consistently find that mothers who elect to breastfeed are, on average, older, have more years of formal education, and report higher household incomes than women who formula feed. In addition, these women tend to have social support, such as mothers, family, and/or friends, and live with the baby's father.Women choose their feeding method based on perceived benefits to themselves and/or their infants. In addition, mothers report cho...

In the United States at this time, no uniform federal law exists regarding commercial surrogacy, and state statutory schemes vary vastly, ranging from criminalization to legal recognition with contract enforcement. The authors examine how commercial surrogacy agencies utilize the Internet as a means for attracting parents and surrogates by employing emotional cultural rhetoric. By inducing both parents and surrogates to their jurisdiction, agencies circumvent vast discrepancies in state statutory regulative schemes and create a distinct interstate business, absent an efficient regulatory framework or legal recourse in some circumstances. The authors propose a uniform federal regulatory scheme premised upon regulating interstate business transactions to create accountability and legal remedies for both the parents and the surrogate.

The concept of brain death--first defined decades ago--still presents medical, ethical, and legal challenges despite its widespread acceptance in clinical practice and in law. This article reviews the medicine, law, and ethics of brain death, including the current inconsistencies in brain death determinations, which a lack of standardized federal policy promotes, and argues that a standard brain death policy to be used by all hospitals in all states should be created.

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