Emerging post-Dobbs liability concerns for providers handling embryos.

PURPOSE OF REVIEW: This review outlines novel, emerging legal risks for in-vitro fertilization (IVF) providers and patients. RECENT FINDINGS: This article reviews recent antiabortion legal developments that create novel legal risks to IVF. This article examines new potential liability for the handling or managing of embryos, and threats to safe, efficient, standard-of-care practice of IVF. It reviews established US and international judicial and regulatory frameworks based on scientifically grounded recognition of IVF embryos as deserving of 'special respect', and finds this approach to be an alternative for law and policy makers. SUMMARY: Defining life as 'beginning at fertilization' (or 'conception') or otherwise embracing 'embryonic personhood' creates emerging legal vulnerabilities and concerns for IVF patients and professionals who handle embryos and threatens standard-of-care IVF. Internationally and domestically established, scientifically grounded understandings of IVF embryos, rather than religious beliefs, should be the basis for legal frameworks that accord appropriate - but not unlimited - protections to IVF embryos. This article presents this framework as an alternative to the current path being embraced by some US policymakers and courts, as a means of protecting the rights of patients, providers and the families they create.

Potentiality switches and epistemic uncertainty: the Argument from Potential in times of human embryo-like structures.

Recent advancements in developmental biology enable the creation of embryo-like structures from human stem cells, which we refer to as human embryo-like structures (hELS). These structures provide promising tools to complement-and perhaps ultimately replace-the use of human embryos in clinical and fundamental research. But what if these hELS-when further improved-also have a claim to moral status? What would that imply for their research use? In this paper, we explore these questions in relation to the traditional answer as to why human embryos should be given greater protection than other (non-)human cells: the so-called Argument from Potential (AfP). According to the AfP, human embryos deserve special moral status because they have the unique potential to develop into persons. While some take the development of hELS to challenge the very foundations of the AfP, the ongoing debate suggests that its dismissal would be premature. Since the AfP is a spectrum of views with different moral implications, it does not need to imply that research with human embryos or hELS that (may) have 'active' potential should be completely off-limits. However, the problem with determining active potential in hELS is that this depends on development passing through 'potentiality switches' about the precise coordinates of which we are still in the dark. As long as this epistemic uncertainty persists, extending embryo research regulations to research with specific types of hELS would amount to a form of regulative precaution that as such would require further justification.

A critical view on using "life not worth living" in the bioethics of assisted reproduction.

This paper critically engages with how life not worth living (LNWL) and cognate concepts are used in the field of beginning-of-life bioethics as the basis of arguments for morally requiring the application of preimplantation genetic diagnosis (PGD) and/or germline genome editing (GGE). It is argued that an objective conceptualization of LNWL is largely too unreliable in beginning-of-life cases for deriving decisive normative reasons that would constitute a moral duty on the part of intending parents. Subjective frameworks are found to be more suitable to determine LNWL, but they are not accessible in beginning-of-life cases because there is no subject yet. Conceptual and sociopolitical problems are additionally pointed out regarding the common usage of clear case exemplars. The paper concludes that a moral requirement for the usage of PGD and GGE cannot be derived from the conceptual base of LNWL, as strong reasons that can be reliably determined are required to limit reproductive freedom on moral grounds. Educated predictions on prospective well-being might still be useful regarding the determination of moral permissibility of PGD and/or GGE. It is suggested that due to the high significance of subjective experience in the normativity of beginning-of-life bioethics, the discipline is called to more actively realize the inclusion of people with disabilities. This regards for instance research design, citation practices, and language choices to increase the accessibility of societal debates on the reproductive ethics of genetic technologies.

Orphans cannot be after-birth aborted: a response to Bobier.

I offer a response to an objection to my account of the moral difference between fetuses and newborns, an account that seeks to address an analogy between abortion and infanticide, which is based on the apparent equality of moral value of fetuses and newborns.

Egalitarianism, moral status and abortion: a reply to Miller.

Calum Miller recently argued that a commitment to a very modest form of egalitarianism-equality between non-disabled human adults-implies fetal personhood. Miller claims that the most plausible basis for human equality is in being human-an attribute which fetuses have-therefore, abortion is likely to be morally wrong. In this paper, I offer a plausible defence for the view that equality between non-disabled human adults does not imply fetal personhood. I also offer a challenge for Miller's view.

Human equality arguments against abortion.

In this paper, I argue that a commitment to a very modest form of egalitarianism-equality between non-disabled human adults-implies fetal personhood. Since the most plausible bases for human value are in being human, or in a gradated property, and since the latter of which implies an inequality between non-disabled adult humans, I conclude that the most plausible basis for human equality is in being human-an attribute which fetuses have.

Pregnancy and superior moral status: a proposal for two thresholds of personhood.

In this paper, I suggest that, if we are committed to accepting a threshold approach to personhood, according to which all beings above the threshold are persons with equal moral status, there are strong reasons to also recognise a second threshold that would be reached through human pregnancy, and that would confer on pregnant women a temporary superior moral status. This proposal is not based on the moral status of the fetus, but on the moral status of the pregnant woman. It is not only the fetus which is an organism sui generis: the pregnant woman, also, is a unique being. Following almost any view on the moral status of the fetus, the pregnant woman should be regarded, herself, as more than a singular individual. She is, herself, 'more than one'. Pregnant women are also necessary for the continued survival of the human species, and there are important justice-based reasons to recognise the higher status. Furthermore, the recognition of a superior moral status for pregnant women does not imply that pregnancy should always be viewed as desirable, or imply any position on the permissibility of abortion. My proposal is not as radical as it might seem, as it does not require that pregnant women should always receive superior treatment, but only that they should to some extent. It could have a range of potential positive practical consequences. Finally, my approach does not threaten, but rather promotes, human equality.

Facts and doubts on the beginning of human life - scientific, legal, philosophical and religious controversies.

It is very complicated to give correct answer to the question "How to define human life?" Nowadays dilemmas consider the respect of human life from the birth to death involve not just biology but also other sciences like philosophy, theology, sociology, psychology, law and politics. These sciences evaluate the topic from different points of view. Integration of all of these perspectives could result with a proper definition. The principal purpose of this paper is to try to determine when a human individual begins. If this proves to be too difficult, we might have to settle for a specific stage in the reproductive process before which it would be impossible to say with any plausibility that a human individual exists. It is necessary to return the moral dimension of observation to the science of life. The point is to reconcile the universal ethical principles concerning the absolute value of life with the everyday challenges and dilemmas. It is our deepest conviction that life has an absolute value and that there always remains something indestructible and substantial in life, which may neither be evaluated by anything final, nor completely reduced to the material biological equivalent and the genetic substratum.

Miscarriage, Abortion, and Disease.

The frequency of death from miscarriage is very high, greater than the number of deaths from induced abortion or major diseases. Berg (2017 , Philosophical Studies 174:1217-26) argues that, given this, those who contend that personhood begins at conception (PAC) are obliged to reorient their resources accordingly-towards stopping miscarriage, in preference to stopping abortion or diseases. This argument depends on there being a basic moral similarity between these deaths. I argue that, for those that hold to PAC, there are good reasons to think that there is no such similarity. There is a morally relevant difference between preventing killing and letting die, giving PAC supporters reasons to prioritize reducing abortion over reducing miscarriage. And the time-relative interest account provides a morally relevant difference in the badness of death of miscarriages and deaths of born adults, justifying attempts to combat major diseases over attempts to combat miscarriage. I consider recent developments in the literature and contend that these new arguments are unsuccessful in establishing moral similarities between deaths from miscarriage and abortion, and deaths from miscarriage and disease.

The moral status of human embryo-like structures: potentiality matters?: The moral status of human synthetic embryos.

New techniques to generate and culture embryo-like structures from stem cells require a more fine-grained distinction of potential to define the moral status of these structures.

Does birth matter?

This paper is a response to a recent paper by Bobier and Omelianchuk in which they argue that the critics of Giubilini and Minerva's defence of infanticide fail to adequately justify a moral difference at birth. They argue that such arguments would lead to an intuitively less plausible position: that late-term abortions are permissible, thus creating a dilemma for those who seek to argue that birth matters. I argue that the only way to resolve this dilemma, is to bite the naturalist bullet and accept that the intuitively plausible idea that birth constitutes a morally relevant event is simply mistaken and biologically misinformed.

Why appeals to the moral significance of birth are saddled with a dilemma.

In 'Dilemma for Appeals to the Moral Significance of Birth', we argued that a dilemma is faced by those who believe that birth is the event at which infanticide is ruled out. Those who reject the moral permissibility of infanticide by appeal to the moral significance of birth must either accept the moral permissibility of a late-term abortion for a non-therapeutic reason or not. If they accept it, they need to account for the strong intuition that her decision is wrong as well as deny the underlying normative principle that killing a viable fetus requires good reason, and not wanting to care for the child when the child could be easily placed for adoption is not a good enough reason to abort. If they reject the moral permissibility of the late-term abortion, they need to explain why her decision is wrong. Doing so, however, will undermine their own project of denying infanticide by appeal to birth. Walter Veit argues that the dilemma relies too much on intuition and does not live up to biological continuity. We explain why his criticisms are unconvincing.

Inconsistency arguments still do not matter.

William Simkulet has recently criticised Colgrove et al's defence against what they have called inconsistency arguments-arguments that claim opponents of abortion (OAs) act in ways inconsistent with their underlying beliefs about human fetuses (eg, that human fetuses are persons at conception). Colgrove et al presented three objections to inconsistency arguments, which Simkulet argues are unconvincing. Further, he maintains that OAs who hold that the fetus is a person at conception fail to act on important issues such as the plight of frozen embryos, poverty and spontaneous abortion. Thus, they are morally negligent. In response, we argue that Simkulet has targeted a very narrow group of OAs, and so his criticisms are inapplicable to most OAs. We then explain why his responses to each of Colgrove et al's objections do not succeed, even for this restricted group. Finally, we note that Simkulet fails to provide evidence for his claims regarding OAs' supposed failures to act, and we show that OAs veritably do invest resources into these important issues. We conclude that Colgrove et al's reasons for rejecting inconsistency arguments (en masse) remain intact.

Progesterone: The Key Factor of the Beginning of Life.

Progesterone is the ovarian steroid produced by the granulosa cells of follicles after the LH peak at mid-cycle. Its role is to sustain embryo endometrial implantation and ongoing pregnancy. Other biological effects of progesterone may exert a protective function in supporting pregnancy up to birth. Luteal phase support (LPS) with progesterone is the standard of care for assisted reproductive technology. Progesterone vaginal administration is currently the most widely used treatment for LPS. Physicians and patients have been reluctant to change an administration route that has proven to be effective. However, some questions remain open, namely the need for LPS in fresh and frozen embryo transfer, the route of administration, the optimal duration of LPS, dosage, and the benefit of combination therapies. The aim of this review is to provide an overview of the uterine and extra-uterine effects of progesterone that may play a role in embryo implantation and pregnancy, and to discuss the advantages of the use of progesterone for LPS in the context of Good Medical Practice.

Why we should not extend the 14-day rule.

The 14-day rule restricts the culturing of human embryos in vitro for the purposes of scientific research for no longer than 14 days. Since researchers recently developed the capability to exceed the 14-day limit, pressure to modify the rule has started to build. Sophia McCully argues that the limit should be extended to 28 days, listing numerous potential benefits of doing so. We contend that McCully has not engaged with the main reasons why the Warnock Committee set such a limit, and these still remain valid. As a result, her case for an extension of the 14-day rule is not persuasive.

The moral status of the fetus: Implications of the somatic integration definition of human life.

This account of the moral status of the human fetus makes four interlocking claims, which together comprise the Fetal Life Moral Status Thesis: (1) life as a human organism begins at the fetal stage of development; (2) the non-organismal life of the human embryo begins at fertilization; (3) the human fetus has intrinsic moral status as a human being; and (4) the human embryo has extrinsic moral status as a non-organismal human individual. The somatic integration definition of human life functions as a premise in two supporting arguments: the Fetal Life Argument and the Fetal Moral Status Argument. These arguments are articulated, objections are considered, and the resulting account of the moral status of the human fetus is applied to the problem of abortion.

The differentiation argument: If newborns outrank animals, so do fetuses.

Common-sense morality seems to dictate that newborn babies strictly outrank non-human animals on an ordered list of subjects of moral consideration. This is best described as the view that newborn babies have a higher moral status than any non-human animal. In this article, I will argue that this common-sense claim about the special moral status of newborn babies makes it hard to avoid the conclusion that fetuses, including pre-conscious fetuses, also have a higher moral status than any non-human animal-indeed, as high as newborn babies. While this conclusion does not quite entail that abortion is generally seriously immoral, it does seem to follow that it would be no less difficult to justify (even relatively early) abortion than it would be to justify killing a newborn.

The Scientific Consensus on When a Human's Life Begins.

Peer-reviewed journals in the biological and life sciences literature have published articles that represent the biological view that a human's life begins at fertilization ("the fertilization view"). As those statements are typically offered without explanation or citation, the fertilization view seems to be uncontested by the editors, reviewers, and authors who contribute to scientific journals. However, Americans are split on whether the fertilization view is a "philosophical or religious belief" (45%) or a "biological and scientific fact" (46%), and only 38% of Americans view fertilization as the starting point of a human's life. In the two studies that explored experts' views on the matter, the fertilization view was the most popular perspective held by public health and IVF professionals. Since a recent study suggested that 80% of Americans view biologists as the group most qualified to determine when a human's life begins, experts in biology were surveyed to provide a new perspective to the literature on experts' views on this matter. Biologists from 1,058 academic institutions around the world assessed survey items on when a human's life begins and, overall, 96% (5337 out of 5577) affirmed the fertilization view. The founding principles of the field Science Communication suggest that scientists have an ethical and professional obligation to inform Americans, as well as people around the world, about scientific developments so members of the public can be empowered to make life decisions that are consistent with the best information available. Given that perspective-and a recent study's finding that a majority of Americans believe they deserve to know when a human's life begins in order to make informed reproductive decisions-science communicators should work to increase the level of science awareness on the fertilization view, as it stands alone as the leading biological perspective on when a human's life begins.

CONTROVERSIES ON THE BEGINNING OF HUMAN LIFE - SCIENCE AND RELIGION CLOSER AND CLOSER.

One of the most controversial topics in modern bioethics, science, and philosophy is the beginning of individual human life. In the seemingly endless debate, strongly stimulated by recent technologic advances in human reproduction, a synthesis between scientific data and hypothesis, philosophical thought, and issues of humanities has become a necessity to deal with ethical, juridical, and social problems. Furthermore, in this field there is a temptation to ask science to choose between opinions and beliefs, which neutralize one another. The question of when human life begins requires the essential aid of different forms of knowledge. Here we become involved in the juncture between science and religion, which needs to be carefully explored. Modern bioethics and science are strongly concerned for the respect of human life at both ends of its existence (birth and death), but other sciences (eg. Philosophy, technology, psychology, sociology, law, and politics) consider the beginning of human life according to different points of view. However, bioethical topics like this one cannot be treated from only one perspective (eg. Biological, philosophical, or religious) because conclusions might be not good enough or reductive. This reality should be regarded in all its richness: An embryo gives a biologist and a geneticist substance for consideration, but because we are talking about the beginning of human life, it requires philosophical-anthropological consideration and confrontation with theology; in its protection we have to include ethics and law. In experiencing and investigating social behavior, other disciplines, such as the history of medicine and sociology, have to be included. It is hard to answer the question when human life should be legally protected. At the time of conception? At the time of implantation? At the time of birth? In all countries (except Ireland and Liechtenstein) juridical considerations are based on Roman law. Roman civil law says that the fetus has right when it is born or if it is born-nasciterus. Few countries agree with definition of beginning of human personality at the time of conception. The majority does not grant legal status to the human embryo in vitro (i.e., during the 14 days after fertilization). Thus, even in the absence of legal rights, there is no denying that the embryo constitutes the beginning of human life, a member of the human family. Therefore, whatever the attitude, every country has to examine which practices are compatible with the respect of that dignity and the security of human genetic material.The question when a human life begins and how to define it, could be answered only through the inner-connecting pathways of history, philosophy, medical science and religion. It has not been easy to determine where to draw the fine line between the competence of science and methaphysics in this delicate philosophical field. To a large extent the drawing of this line depends on one's fundamental philosophical outlook. The point at which human life begins will always be seen differently by different individuals, groups, cultures, and religious faiths. In democracy there are always at least two sides, and the center holds only when the majority realizes that without a minority democracy itself is lost. The minority in turn must realize its best chance lies in persuasion by reason and thoughtfulness rather than fanaticism.

The Beginning of Life Issues: An Islamic Perspective.

Islam gives legal precedence to purity of lineage and known parenthood of all children. In Islam treatment to infertility using IVF is permitted within validity of marriage contract with no genes mixing. The paper shows that the Qur'an, the word of Allah, and science, the deeds of Allah are not in major conflicts in defining the start of human life. The Holy Qur'an provides an elegant description of origin, developmental stages of intra-uterine life. The Hadith explains two positions one that believes human embryo get ensouled at conception and the other after 40 days of conception. The paper aims to find that Islam confers moral respect to human embryo, but it also clarifies the absence of full human rights to a developing foetus. In Islam, human embryonic use is probably permissible for therapeutic and reproductive purpose keeping intact the principles of Shari'ah.