RESUMO
United States law recognizes adult reproductive liberty and many states view surrogacy services through that lens. During the COVID-19 pandemic in March, 2020, New York State enacted the Child-Parent Surrogacy Act (CPSA) into law, after feminists and their allies had caused its defeat in 2019. Just before approval of the CPSA, a group of legislators introduced the Alternative Surrogacy Bill (ASB). This article is a case study that examines how the CPSA and not the ASB became law, examining surrogate rights, the best interests of the child, and the ethical issues related to adult donor-conceived and surrogacy born children's rights to information about their ancestry.
Assuntos
Comércio/legislação & jurisprudência , Direitos Humanos , Legislação Médica/ética , Técnicas Reprodutivas/legislação & jurisprudência , Controle Social Formal , Mães Substitutas/legislação & jurisprudência , Acesso à Informação , Adulto , COVID-19 , Criança , Proteção da Criança , Comércio/ética , Infecções por Coronavirus/epidemiologia , Dissidências e Disputas , Família , Feminino , Humanos , Indústrias/ética , Indústrias/legislação & jurisprudência , Mães , New York/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Gravidez , Técnicas Reprodutivas/economia , Técnicas Reprodutivas/ética , Direitos da MulherAssuntos
Técnicas Reprodutivas , Justiça Social , Brasil/epidemiologia , Epidemias , Feminino , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/ética , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Disparidades nos Níveis de Saúde , História do Século XX , História do Século XXI , Humanos , Recém-Nascido , Seguro Saúde/economia , Seguro Saúde/ética , Seguro Saúde/legislação & jurisprudência , Legislação como Assunto/tendências , Masculino , Gravidez , Técnicas Reprodutivas/economia , Técnicas Reprodutivas/ética , Técnicas Reprodutivas/legislação & jurisprudência , Fatores de Risco , Justiça Social/ética , Justiça Social/legislação & jurisprudência , Justiça Social/tendências , Fatores SocioeconômicosRESUMO
In the past 50 years the incidence of multiple pregnancies has increased dramatically due almost exclusively to two factors: delayed childbearing and assisted reproductive techniques. In this paper we analyze the variations in the incidence of multiple gestations in Andalusia, one of the biggest administrative regions in Spain, over the last decade. Assisted reproduction techniques are very often evaluated only in terms of implantation and pregnancy rates per cycle, ignoring everything related to complications of multiple births, prematurity or economic overload. The rate of twins in Andalusia has increased from 10.9 per thousand in 2000 to 16.2 per thousand in 2009. The rate of triplet births has also increased in recent years. After a decline in 2003, motivated by promulgation of the first Human Assisted Reproduction Law, there was an increase after a second law came into effect in 2006. Health care spending attributable to the excess of multiple pregnancies reported in the decade 2000-2010 may have been much higher than 25 million.
Assuntos
Infertilidade Feminina/epidemiologia , Prole de Múltiplos Nascimentos/estatística & dados numéricos , Técnicas Reprodutivas/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde , Humanos , Incidência , Recém-Nascido , Infertilidade Feminina/economia , Infertilidade Feminina/terapia , Gravidez , Resultado da Gravidez , Taxa de Gravidez , Gravidez Múltipla , Técnicas Reprodutivas/economia , EspanhaRESUMO
Since the 1980s, increasingly more fertility treatments have been performed in the Netherlands. The use of ovarian hyperstimulation during in vitro fertilisation (IVF) and intrauterine insemination (IUI) has contributed to an explosive increase in the number of multiple births. To control the costs of treatment and outcomes, the Minister of Health, Welfare and Sport commissioned research on possible improvements in the performance of fertility treatments in 1999. The results of this research ('Umbrella study'), reported in 2005, suggested that costs and the incidence of multiple births could be reduced if (a) IUI is only performed if the chance of spontaneous pregnancy is less than 30%; (b) the guideline 'Intrauterine insemination' is followed more closely regarding hormonal stimulation; (c) stimulation is used less frequently during IVF; and (d) no more than 1 embryo is placed in the uterus at a time. To achieve these results, all parties involved must revise their policies. In particular, current reimbursement regulations inhibit the implementation of the research results in practice.
Assuntos
Infertilidade Feminina/terapia , Prole de Múltiplos Nascimentos , Gravidez Múltipla , Técnicas Reprodutivas/economia , Custos e Análise de Custo , Feminino , Fertilização in vitro/economia , Humanos , Inseminação Artificial/economia , Países Baixos , Gravidez , Resultado da Gravidez , Taxa de Gravidez , Técnicas Reprodutivas/normasAssuntos
Comitês Consultivos , Bioética , Pesquisas com Embriões/ética , Ética em Pesquisa , Política Pública , Células-Tronco , Linhagem Celular , Clonagem de Organismos/economia , Clonagem de Organismos/ética , Clonagem de Organismos/legislação & jurisprudência , Pesquisas com Embriões/economia , Pesquisas com Embriões/legislação & jurisprudência , Financiamento Governamental/legislação & jurisprudência , Humanos , Política , Técnicas Reprodutivas/economia , Técnicas Reprodutivas/ética , Técnicas Reprodutivas/legislação & jurisprudência , Estados UnidosAssuntos
Comitês Consultivos , Bioética , Clonagem de Organismos/ética , Pesquisas com Embriões/ética , Política Pública , Clonagem de Organismos/economia , Clonagem de Organismos/legislação & jurisprudência , Pesquisas com Embriões/economia , Pesquisas com Embriões/legislação & jurisprudência , Comitês de Ética em Pesquisa , Financiamento Governamental/legislação & jurisprudência , Regulamentação Governamental , Humanos , Medicina na Literatura , Princípios Morais , Política , Técnicas Reprodutivas/economia , Técnicas Reprodutivas/ética , Técnicas Reprodutivas/legislação & jurisprudência , Estados UnidosAssuntos
Aconselhamento , Infertilidade/enfermagem , Técnicas Reprodutivas/enfermagem , Custos e Análise de Custo , Aconselhamento/economia , Feminino , Alemanha , Humanos , Recém-Nascido , Infertilidade/economia , Infertilidade/psicologia , Masculino , Gravidez , Técnicas Reprodutivas/economia , Técnicas Reprodutivas/psicologia , Falha de TratamentoRESUMO
The variable nature of NHS provision of fertility services has again been highlighted by the response of commissioners to the recent guidance from the National Institute of Clinical Excellence. This paper describes an evidence-based model for policy aimed at minimising inequity across one Strategic Health Authority. The paper highlights the difficulties resulting from the current Department of Health guidance on targeting those in greatest need. A different way of describing this group is proposed, namely, defining childlessness in terms of parental status alone. This is clear to both patient and clinician at the outset, not subject to variable interpretation and because it is quantifiable for any given population, facilitates the commissioning of a level of service provision that reflects expressed need. A clinical audit suggests that the annual incidence of fertility problems prompting attendance at secondary care clinics is similar to levels observed nearly 20 years ago, at around 98 per 10,000 of the fertile population (proxy denominator, women aged 25 - 39). Our model further indicates that, for the more complex treatments, if both partners were required to be childless and treatments were to be delivered within 12 - 18 months of listing, commissioners would need to fund treatment for around 15 - 20 patients per 10,000 of the fertile population. If only one partner was required to be childless this figure would rise by 15 - 20%. We argue that despite the clinical guidelines, fertility treatments will remain a 'postcode lottery' unless central government addresses the priority to be given to fertility treatment on a national basis.
Assuntos
Financiamento Governamental , Infertilidade/terapia , Técnicas Reprodutivas/economia , Adulto , Definição da Elegibilidade , Feminino , Fertilização in vitro/economia , Custos de Cuidados de Saúde , Política de Saúde , Homossexualidade , Humanos , Masculino , Estado Civil , Reino Unido , Listas de EsperaAssuntos
Infertilidade/terapia , Gravidez Múltipla , Transferência Embrionária , Feminino , França , Humanos , Gravidez , Complicações na Gravidez/epidemiologia , Redução de Gravidez Multifetal , Gravidez Múltipla/estatística & dados numéricos , Técnicas Reprodutivas/efeitos adversos , Técnicas Reprodutivas/economia , Técnicas Reprodutivas/legislação & jurisprudência , TrigêmeosRESUMO
Nowadays, the use of urinary FSH is essentially justified by a lower acquisition price compared to modern products generated by Biotechnology (recombinant FSH). However, the public price of a product is only one element of the total cost of a therapeutic regimen that must be taken into account in medical decision-making. This is the role of pharmacoeconomic studies including cost-effectiveness models, which allow proceeding to complex situational comparisons such as several attempts of Assisted Reproduction Techniques. Different models have been carried out and published in several countries and present consistently that recombinant FSH is more cost-effective that urinary derived FSH.
Assuntos
Farmacoeconomia , Hormônio Foliculoestimulante/economia , Hormônio Foliculoestimulante/urina , Proteínas Recombinantes/economia , Análise Custo-Benefício , Feminino , Humanos , Gravidez , Técnicas Reprodutivas/economiaRESUMO
This Article considers whether infertile taxpayers can deduct their fertility treatment costs as medical expenses under Internal Revenue Code section 213 and whether they should be able to deduct them. Internal Revenue Code section 213 defines medical expenses as "amounts paid-for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body." This definition is interpreted by reference to a baseline of normal biological functioning, which includes reproductive functioning. Most people conceive and bear children without having to incur expenses for fertility treatment. Expenses incurred to approximate the baseline of normal reproductive health are deductible, even if the taxpayer winds up better off, with a child, after the fertility treatment. The medical profession recognizes that infertility is a disease or condition. Infertility is a loss, just as a broken leg is a loss. Fertility treatment costs are thus medical expenses under section 213. In addition, given the existence of the medical expense deduction, taxpayers should be able to deduct the cost of fertility treatments, including IVF, egg donor, and surrogate procedures, under either an "ability-to-pay" or consequentialist normative approach. Reproduction is extremely important to most people. In addition, allowing taxpayers to deduct the costs of fertility treatment will encourage infertile taxpayers to elect the most effective treatment option and reduce the rate of risky multifetal pregnancies. This Article concludes that fertility treatment costs are deductible as medical expenses under current law and should be deductible as medical expenses.
Assuntos
Dedutíveis e Cosseguros , Serviços de Planejamento Familiar/economia , Seguro Saúde/economia , Impostos , Serviços de Saúde da Mulher/economia , Honorários e Preços , Feminino , Fertilidade , Recursos em Saúde/economia , Recursos em Saúde/legislação & jurisprudência , Humanos , Infertilidade Feminina/economia , Infertilidade Feminina/psicologia , Infertilidade Feminina/terapia , Infertilidade Masculina/economia , Infertilidade Masculina/psicologia , Infertilidade Masculina/terapia , Masculino , Política , Gravidez , Técnicas Reprodutivas/economia , Técnicas Reprodutivas/legislação & jurisprudência , Estados UnidosAssuntos
Androgênios/metabolismo , Endocrinologia , Técnicas Reprodutivas , Endocrinologia/ética , Ética Médica , Custos de Cuidados de Saúde , Humanos , Infertilidade Masculina/fisiopatologia , Infertilidade Masculina/psicologia , Infertilidade Masculina/terapia , Masculino , Técnicas Reprodutivas/economia , Técnicas Reprodutivas/éticaAssuntos
Efeitos Psicossociais da Doença , Infertilidade/terapia , Programas Nacionais de Saúde/economia , Técnicas Reprodutivas , França/epidemiologia , Humanos , Infertilidade/economia , Infertilidade/epidemiologia , Infertilidade/psicologia , Técnicas Reprodutivas/efeitos adversos , Técnicas Reprodutivas/economia , Técnicas Reprodutivas/psicologia , Fatores de RiscoRESUMO
BACKGROUND: Although the donation and receipt of gametes has become an integral part of infertility management, previous research in the field of social attitudes and intention to use medical technologies is limited. This study aimed to investigate attitudinal indicators and their potential relationship with the public's intention to have recourse to gamete donation and surrogacy. METHODS: A total of 365 individuals of reproductive age (49.3% men and 50.7% women) completed a questionnaire referring to their intention to receive or donate sperm/oocytes and their acceptance of becoming a commissioning couple or surrogate mother, and also to explore their attitudes towards gamete donation and surrogacy. Two attitudinal indicators emerged from the principal component analysis identifying (i). recipients' and donors' choice for anonymity, donors' renunciation of parental obligations and refusal of children's rights to know their biological parents and (ii). favourable attitudes towards legislative and financial measures to be adopted by the Government for the promotion of reproductive technologies. RESULTS: It was found that the indicator of 'Donors Anonymity and Refusal of Children's Rights' (DARCR) and the 'Legislative and Financial Support' (LFS) scale are positively associated with intention to have recourse to Gamete Donation and Surrogacy (GDS) (regression coefficients 0.31 and 1.08 respectively). Moreover, among the other variables used in the analysis only the 'church attendance' variable is negatively related with reported rates of intention to have recourse to GDS (P = 0.029), suggesting that the more religious respondents are less willing to use GDS. CONCLUSION: Social, legislative and financial implications provide a convenient rationale for adopting a favourable intention towards reproductive technologies. The findings of the present research should be given close consideration by policy makers and health education campaigns.
Assuntos
Atitude , Células Germinativas , Opinião Pública , Mães Substitutas , Doadores de Tecidos , Adulto , Criança , Revelação , Feminino , Direitos Humanos , Humanos , Masculino , Pais , Análise de Componente Principal , Técnicas Reprodutivas/economia , Técnicas Reprodutivas/legislação & jurisprudência , Responsabilidade Social , Inquéritos e QuestionáriosAssuntos
Infertilidade Masculina/psicologia , Infertilidade Masculina/terapia , Pais/psicologia , Traumatismos da Medula Espinal/complicações , Adaptação Psicológica , Adulto , Feminino , Humanos , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/etiologia , Masculino , Poder Familiar/psicologia , Técnicas Reprodutivas/economia , Técnicas Reprodutivas/psicologia , Técnicas Reprodutivas/normasAssuntos
Mitocôndrias/transplante , Óvulo , Técnicas Reprodutivas , Animais , Citoplasma/transplante , Regulamentação Governamental , Humanos , Mitocôndrias/genética , Modelos Animais , National Institutes of Health (U.S.) , Opinião Pública , Política Pública , Técnicas Reprodutivas/economia , Apoio à Pesquisa como Assunto , Estados Unidos , United States Food and Drug AdministrationRESUMO
The prevalence of infertility has increased in recent years, but the medical services to treat these problems are not available for most of the affected couples. The prognosis for fertility is important in order to determine the therapeutic capacity of each service, and to select the couples that could be treated at a primary level, or to send them to more advanced levels of reproductive technology. In practice, the infertility is treated in primary medical levels and the assisted reproductive technology is available only to a limited sector of the poblation. In general, the managed-care plans do not compensate directly for infertility treatments, but they are indirectly paying some therapeutic procedures for fertility.