Inclusion, exclusion: Comparative public policy (France/USA) in access to assisted reproductive technology.

This article examines what French and American societies mean by the principle of personal autonomy/'right to privacy' and the concept of solidarity/'the best interest of the society at large'. It will attempt to show how these two countries translate these concepts into different public policies, more specifically in the field of access to sexual and reproductive rights of women and men. In order to better highlight these differences, I observe what citizens actually experience on the ground, and in so doing, it becomes clear that each country does not fully meet the principles they purport to defend.

Dead-End in Sight: France Struggles with Surrogacy and Cross-Border Practices.

This article addresses the issue and practice of surrogacy in France. Surrogacy contracts are void under French law, and intermediaries, medical personnel, and in some cases, parents can be penalized if they partake in this method of ART. Consequently, the vast majority of French children born of surrogacy result from cross-border practices that their parents undertake. Divided into three parts, this chapter will first explore the French legal framework of surrogacy, then explore the cross-border practices at play and the difficulties they raise for ensuing parents and children once back on French soil, and finally examines diverse social movements and discourse either for or against the legalization of surrogacy in France. It concludes by arguing that before establishing a regulatory framework for surrogacy, the most pressing issue is to protect children born of French parents abroad via surrogacy once the family returns to the country.

[A historical approach to the issues of gender and health]. / Une approche historique des enjeux de genre et de santé.

From the 1980s, the dissociation of sexuality and reproduction has led to questioning on the "evidence" of the female-male categories. The United States were the first to take governmental initiatives to offset the under-representation of women, particularly in the field of research. They were followed, twenty years later, by the European Community. However, inequalities between women and men persist today. It seems obvious that only proactive measures can help to improve this situation.

Phthalate-associated hypertension in premature infants: a prospective mechanistic cohort study.

BACKGROUND: Phthalates are associated with increased blood pressure in children. Large exposures to di-(2-ethylhexyl) phthalate (DEHP) among premature infants have been a cause for concern. METHODS: We conducted a prospective observational cohort study to determine if DEHP exposures are related to systolic blood pressure (SBP) in premature infants, and if this exposure is associated with activation of the mineralocorticoid receptor (MR). Infants were monitored longitudinally for 8 months from birth. Those who developed idiopathic hypertension were compared with normotensive infants for DEHP exposures. Appearance of urinary metabolites after exposure was documented. Linear regression evaluated the relationship between DEHP exposures and SBP index and whether urinary cortisol/cortisone ratio (a surrogate marker for 11ß-HSD2 activity) mediated those relationships. Urinary exosomes were quantified for sodium transporter/channel expression and interrogated against SBP index. RESULTS: Eighteen patients met the study criteria, nine developed transient idiopathic hypertension at a postmenstrual age of 40.6 ± 3.4 weeks. The presence of urinary DEHP metabolites was associated with prior IV and respiratory tubing DEHP exposures (p < 0.05). Both IV and respiratory DEHP exposures were greater in hypertensive infants (p < 0.05). SBP index was related to DEHP exposure from IV fluid (p = 0.018), but not respiratory DEHP. Urinary cortisol/cortisone ratio was related to IV DEHP and SBP index (p < 0.05). Sodium transporter/channel expression was also related to SBP index (p < 0.05). CONCLUSIONS: Increased blood pressure and hypertension in premature infants are associated with postnatal DEHP exposure. The mechanism of action appears to be activation of the MR through inhibition of 11ß-HSD2.

[New reproductive technologies in the United States: law(s) and practice(s)]. / Les nouvelles technologies de reproduction - État des lieux aux États-Unis.

This article presents a panorama of laws and guidelines governing the practice of NRT in the US in general, and surrogacy in particuliar. Special attention is given to what the author deems to be four « models ¼ governing frameworks for surrogacy where all parties are protected, beginnning with the surrogate herself.

Fostering responsible research with genome editing technologies: a European perspective.

In this consensus paper resulting from a meeting that involved representatives from more than 20 European partners, we recommend the foundation of an expert group (European Steering Committee) to assess the potential benefits and draw-backs of genome editing (off-targets, mosaicisms, etc.), and to design risk matrices and scenarios for a responsible use of this promising technology. In addition, this European steering committee will contribute in promoting an open debate on societal aspects prior to a translation into national and international legislation.

Privacy, autonomy, and public policy: French and North American perspectives.

This article raises the question of whether in both the United States and in France, an individual's autonomy and private decision-making right(s) in matters of health care and access to reproductive technologies can be conciliated with the general interest, and more specifically, the role of the State. Can a full-fledged right to privacy, the ability to exercise one's autonomy, exist alongside the general interest, and depend neither on financial resources like in the United States nor on centralised government decisions or the medical hierarchy like in France? The contrast between these two modern democracies justify the importance of comparing them. I will demonstrate that overlaps do exist: the free exercise of religion and opinion, freedom of expression, the inherent value of each individual. What differs, however, are the institutions and how they provide, protect, promote, or frame access to and expressions of these democratic principles. The impact of the global economy, the exposure of people around the world to each other via the internet, and the mirror effects of social media, blogs, and other such forums, have created new perspectives that countries project onto one another. For example, does France now seem to tout 'autonomy' as a new and important value because it appears to be an 'American success story'? Does the United States now seem to value human rights and a social-democratic approach because of the 'French model'? There seems to be some truth behind these assertions, but as this article will demonstrate, the portrayals of what the 'right to privacy' is in the United States and what 'socialised medicine' is in France are not necessarily fully accurate.

Assisted reproductive technology (ART) in the United States: towards a national regulatory framework?

In most of the industrialized world, comprehensive oversight and/or regulation of assisted reproductive technology has been in place for some time now. For example, in countries such as France or the UK, fertility clinics are licensed by a government agency. This arrangement allows for rules to be modified as needed, and also provides a mechanism for ensuring that clinics are following them. Rules about permitted procedures, guided by consistent principles, are set and enforced by the licensing agency. Above all, countries that regulate assisted reproduction differ from the United States in one very crucial way: they regard health care as a right and provide it to their citizens. This paper will offer a panorama of the practice of assisted reproductive technology (ART) in the United States, present some key events and the contemporary context that have provoked an urgent call for national regulation, examine some states wherein regulation exits, and estimate the possibility for a national regulatory framework.