Legal considerations in reproductive medicine.

Legal issues affect reproductive medical practice throughout the entire world. The breadth and depth of this interrelationship extend far beyond the scope of one series of articles in Views and Reviews. Given this limitation, we have chosen to present five topics, all different, but illustrative of key concepts that influence our practice of reproductive medicine. Our hope is that this "medical-legal sampler" will both inform and provoke thoughtful consideration of the ways we can best and most responsibly practice and serve our patients.

Legal principles and essential surrogacy cases every practitioner should know.

Gestational surrogacy, made possible with the introduction of in vitro fertilization, has expanded family building options while introducing novel challenges to established legal principles involving constitutional, contract, and family law as well as duty of care and negligence. Both legislatures and courts have grappled with how to apply these sometimes-competing areas of law to protect participants and professionals, and to create legally secure families. This article explores the following: the Constitutionally protected rights of privacy and reproductive autonomy of gestational surrogates; Contract Law principles that govern surrogacy contracts; the varied ways states have extended Family Law to establish legally recognized parent-child relationships between intended parents and children born to gestational surrogates; and the legal duties of care medical professionals owe to their patients.

Legal principles and seminal legal cases in oocyte donation.

Oocyte donation has played an increasingly important role in assisted reproductive technologies since the early 1980s. Over the past 30 years, unique legal standards have evolved to address issues in the oocyte donation procedure itself as well as the disputes over issues, such as parentage, that inevitably arise with new technologies, particularly for individuals seeking to build nontraditional families. This essay will explore oocyte donation's legal aspects as well as seminal law concerning the procedure, including statutory law (uniform and model provisions and enacted state laws) and selected judicial opinions concerning surrogacy and parentage, testing of oocyte donors, mix-ups of donated oocytes, and donor compensation.

Legal Issues in Gamete and Embryo Cryopreservation: An Overview.

This article provides an overview of existing and developing law surrounding IVF embryos and those who handle them. It discusses what law and legal theories of liability may apply to embryology labs, and gamete and embryo banks in the context of embryo loss, abandonment, shipping and implantation. It explores how often intertwined theories of law have been applied to this unique field, including contract, informed consent, health, tort and Constitutional law. Recent so-called "Personhood" initiatives are reviewed for their impact on ART practice. The article also explores how legal principles related to patient choice, autonomy, informed consent, and the various rights and responsibilities of providers and patients have been applied to this area of medicine which is unique both because it involves at least two patients and due to the singular nature and reproductive potential of ex-utero and cryopreserved embryos and gametes. Through an examination of largely US judicial and statutory perspectives and trends, the article assesses the complexities of the impact of the law on, and attempts to offers guidance to, those involved in this continually evolving and challenging field of medicine.

Growing families in a shrinking world: legal and ethical challenges in cross-border surrogacy.

Crossing national borders to have children is a rapidly growing phenomenon, fuelled by restrictions on access and technologies in some countries and for some patients, by high costs in others, and all generating a burgeoning multibillion dollar international industry. Cross-border gestational surrogacy is one form of family building that challenges legal, policy and ethical norms between countries and puts both intended parents and gestational surrogates at risk, and can leave the offspring of these arrangements vulnerable in a variety of ways, including parent-child, immigration and citizenship status. The widely varying political, religious and legal views amongst countries make line drawing and rule making challenging. This article reviews recent court decisions about and explores the legal dimensions of cross-border surrogacy.

Fighting 'personhood' initiatives in the United States.

'Personhood' initiatives filed in many states within the United States threaten to impose potentially significant restrictions on infertility treatment, embryo disposition, pre-natal care, abortion, contraception, and stem-cell research, all through attempts to redefine a 'person' or 'human being' as existing from the moment of fertilization or conception, and endowed with the full legal and Constitutional rights of personhood. Virginia's recent, unsuccessful attempt to pass such legislation provides both a dramatic example of these efforts and valuable lessons in the fight against them by infertility advocates and others. Arguments over loss of infertility treatment seemed more persuasive to legislatures than did restrictions on abortion or stem cell research. Indeed, persuading legislators or voters that they could be 'pro-life' and still anti-personhood initiatives was a key strategy, and consumer efforts and media attention were instrumental. The most central lessons, however, may be the degree of intensity and coordinated strategy to shift public perception that lie behind these numerous state efforts, regardless of whether the actual initiatives are won or lost.

Legal perspectives on cross-border reproductive care.

Global cross-border reproductive care (CBRC), and the challenges accompanying it, are here to stay. A recent issue of this journal devoted to CBRC provides an extraordinary array of insights into multiple facets, with a focus on the legal dimensions of practices by restrictive countries such as Turkey and Italy. The articles identify restrictive laws that challenge and create vulnerabilities for both citizens and providers involved in CBRC, and call instead for more modest and nuanced legislation and the closing paper presents a thoughtful and ambitious outline for a future research agenda. This commentary reflects on the implications of these legal dimensions, including their applicability to countries with more permissive CBRC policies, discusses three specific examples of legal concerns that have arisen in the USA and identifies numerous legal issues meriting future study. Together with the nuanced, more modest legislation recommended for restrictive countries, consistent legal and judicial principles for CBRC in permissive countries would respect varying perspectives on family building while attempting to address a central legal concern of CBRC, the protection of families, third-parties and providers. Any future agenda should include research and recommendations on the legal dimensions of CBRC in both restrictive and permissive countries.

A legal defense for compensating research egg donors.

Given the continued need for human eggs for hESCs, this article analyzes and refutes the legal theories against compensating research egg donors, contrasts the legal histories of compensating reproductive donors and human subjects with noncompensation for ESC donors, and suggests that limited compensation is legally defensible.

Reproduction, genetics and the law.

Both reproductive medicine and genetics are seeing rapid, and in some instances revolutionary, medical and scientific advances. Courts have been called upon to resolve a variety of novel disputes arising from these areas, and more can be anticipated as these technologies continue to develop and their use becomes more widespread. This article discusses some of the most relevant areas of the law and litigation that currently bear on reproduction and genetics or that may be anticipated to do so in the future. Specific developments and judicial decisions addressing them include: legal theories of wrongful birth and wrongful life and their application to children born with genetic impairments; a physician's duty to warn family members about a relative's genetic disease; disputes over reproductive materials and non-reproductive cells and tissues; unauthorized genetic testing in the workplace; and genetic discrimination. It is hoped that this discussion will be of value to medical and legal professionals and policy makers who work with these concepts in the increasingly inter-related fields of law and medicine.

Legal issues related to parenthood after cancer.

Cancer and procreation raise a host of novel legal issues involving the rights of those trying to create families after cancer treatment and any resulting children, as well as the responsibilities of those who assist them. Recent court decisions, although neither consistent nor plentiful, highlight the emerging legal issues for patients, providers, and offspring. This article explores a number of legal issues related to cancer and parenthood, including: 1) patients' cryopreservation of sperm, eggs, or embryos and subsequent access to and use by them or their former partners; 2) fertility preservation in minor patients; 3) posthumous reproduction and legal parentage issues for children born from cryopreserved embryos or gametes; 4) wrongful life or wrongful birth claims of children born following their parents' cancer treatments; 5) access to, and discrimination in, medical treatment or alternative family-building options; and 6) professional responsibility and liability for providers relating to the potential fertility impact of cancer treatment. The limited, evolving court decisions, through the application of legal principles such as negligence, malpractice, discrimination, and parentage principles, provide some guidance for patients, providers, and policymakers in approaching the unique challenges presented by fertility preservation in the context of cancer treatments.