Identity and reproductive rights of transgenders: are current legal and ethical frameworks soon to be outdated? Medicolegal implications of potentially life-changing decisions.

Abstract: The level of recognition that transgender individuals (i.e. those whose gender does not match the sex assigned at birth) enjoy in our societies has certainly made giant strides. Still, there is no denying that the far-reaching ramifications arising from choices about one's gender expression do affect vital aspects of identity in school, workplaces, and the community, and should be clearly defined and addressed by laws and policies. One of the arguments most commonly used by supporters of transgender rights relies on the concept of inalienable human rights, including the rights to live safely, freely, and without fearing discrimination. The authors have set out to succinctly outline and elaborate on the dynamics that have been shaping the legal reco-gnition of transgender individuals in light of the unique legal, social and ethical complexities that such an evolution entails. Moreover, as assisted reproduction technologies make considerable progress and innovations open up new horizons for fertility preservation and restoration, it is worth exploring how such advance can play a role in upholding the reproductive rights of transgender patients who wish to achieve parenthood, and how counseling ought to be implemented taking into account the psychological traits of transgender patients and the implications of every choice they make.

From the maternal uterus to the "uterus device"? Ethical and scientific considerations on partial ectogenesis.

The article aims to elaborate the progress made in partial ectogenesis research on sheep as well as human embryos. Since the ban on embryos experimentation after the 14-day window is a major roadblock in terms of partial ectogenesis research, the authors have weighed the possibility that such a ban could be reconsidered. In favor of easing such a restriction, it may be argued that: (a) unlike the Catholic approach, prevalent ethics precepts hold that the embryo's interest ought to be balanced against the interests of the other parties involved; (b) an extension of the 14-day deadline would no longer make ethically untenable practices acceptable; hence, the "slippery slope" argument, although generally worthy, would not conclusively apply to partial ectogenesis; (c) in mainstream embryo research efforts, there is a conflict between the lives of embryos and the health of individuals already born; as for partial ectogenesis, however, such a conflict would be between the lives of embryos and the lives of fetuses which would not survive otherwise. Still, in light of the embryo's status as a human being, the authors conclude that such research practices should only be allowed on supernumerary embryos.

Uterus transplant and controversial assisted reproductive technologies: can the right to parenthood clash with ethical precepts?

ABSTRACT: Fast-developing assisted reproductive techniques based on innova- tive technologies have given rise to incredibly consequential ethical challenges of unprecedented scope. The development of innovative assisted reproductive technologies (ARTs) has steadily risen since the late 1970s. Until just over 20 years ago, those who sought to become parents had no way to overcome their infertility or sterility issues, but can now achieve parenthood and have children with at least a partial genetic and/or biological relationship. Treatments aimed at ovarian stimulation, artificial insemination, either by using the sperm of a husband or of an unrelated donor, in vitro fertilization with embryo transfer, gamete and zygote intrafallopian transfers, and intracyto- plasmic sperm injection are among the options currently available. A major ethical quandary linked to ARTs is the one arising from unused embryos, i.e. supernumerary embryos which were not implanted. Still, aside from ethical concerns stemming from embryo rights, in such a fast-evolving field, a solid ethical foundation is absolutely necessary to provide guidance for regulations and legislation. This is especially true considering how assisted reproductive practices such as surrogacy and uterus transplant (UTx) are even more controversial, hence the need to rely on a broadly acknowledged and shared set of principles for their regulation, by virtue of their unique distinctive traits which challenge our ethical and moral compass at its very core.

Living will legislation: between advance healthcare directives and advance care planning, which is the better way to go.

Following drawn out, contentious parliamentary deliberations, the Italian legislature has enacted bill n.219/17, meant to regulate advance healthcare directives. The letter's authors are critical of some key aspects relative to advance directives, contending that it would be preferable to opt for advance care planning, which enables already severely ill patients who are fully aware of the consequences of their disease to choose what therapeutic pathway to undertake.

Advances in Medically-assisted procreation technologies: can malpractice claims and "reproductive damage" be identified.

Medically assisted procreation and assisted reproductive techniques have made giant strides over the past decades, enabling countless couples to achieve parenthood. Still, the ethical and moral concerns that have come to the fore as a result of ART's rise pose a multi-faceted issue that lawmakers have struggled to keep up with; procedures such as heterologous fertilization are strictly regulated, and even banned, in several nations around the globe, among which Italy, where a controversial piece of legislation was passed in 2004; such a reform has been partly nullified by court decisions, among which the Italian Constitutional Court and even the European Court of Human Rights. Relevant scientific articles were identified from Medline, Cochrane Central, Scopus, Web of Science, Science Direct, EMBASE and Google Scholar, through February 2020, by using the following keywords: "assisted reproductive techniques", "heterologous fertilization", "European rulings on ART", "reproductive damages". The rise of ART has laid bare a shortage of adequate legal tools for the purpose of guaranteeing the exercise of reproductive rights for all. Hence, the harmonization of regulations, at least at the European level, is greatly needed in order to ensure equality of parental opportunities for all.