What is Known About Reproductive Autonomy Among Justice-Involved Black Women?: A Scoping Review.

OBJECTIVE: There are approximately 231,000 women detained daily within the nation's jail and prison systems with women of color making up nearly half of those experiencing incarceration. The purpose of this scoping review was to synthesize the literature on the reproductive autonomy of Black women influenced by incarceration, using the three tenets of reproductive justice. METHODS: We searched PubMed, CINAHL, SocINDEX, and PsycINFO for research related to reproductive justice written in English and published in the United States from 1980 to 2022. A review of 440 article titles and abstracts yielded 32 articles for full-text review; nine articles met inclusion. RESULTS: Eight addressed Tenet 1; five mentioned Tenet 2; none addressed Tenet 3. Recognition of the influence of incarceration on the reproductive autonomy of Black women is limited. CONCLUSION: The findings from this review suggest a need to address (a) reproductive choice, (b) support goals, and (c) support of justice-involved Black women.

Preservação da fertilidade em pacientes com câncer ginecológico / Fertility preservation in gynecologic cancer patients

CONTEXTO CLÍNICO O câncer ginecológico afeta diretamente a fertilidade, pois o tratamento consiste na remoção cirúrgica do sistema reprodutor e/ou na sua exposição a agentes gonadotóxicos. Entretanto, pacientes em estádios iniciais e que estejam dentro de critérios estabelecidos podem ser tratadas com cirurgias conservadoras da fertilidade, com resultados oncológicos equivalentes aos dos tratamentos tradicionais. As técnicas de preservação da fertilidade, como criopreservação de oócitos, embriões e tecido ovariano, também podem ser oferecidas em algumas situações. A American Society of Clinical Oncology (ASCO) publicou recomendações sobre a preservação de fertilidade, com o objetivo de aumentar a conscientização sobre o tema, e, juntamente com a American Society for Reproductive Medicine (ASRM), recomenda que pacientes em idade fértil com câncer passem por aconselhamento reprodutivo. Essas pacientes apresentam menores taxas de arrependimento, mesmo quando optam por desistir do tratamento conservador. O interesse na preservação da fertilidade aumentou nas últimas décadas, tanto pelo fato de as mulheres postergarem a gestação como pelo aumento da incidência de câncer em jovens. A taxa de incidência de todos os cânceres aumentou 29% entre 1973 e 2015 em adolescentes e adultos jovens de ambos os sexos. O câncer de colo uterino, em mulheres de 20-29 anos, aumentou anualmente em uma média de 10,3% entre 2000 e 2009. A omissão em orientar pacientes com câncer sobre as possibilidades de preservação da fertilidade pode gerar questionamentos futuros; em alguns países. isso já se configura má prática médica.

Restricted access to assisted reproductive technology and fertility preservation: legal and ethical issues.

Access to assisted reproductive technology (ART) and fertility preservation remains restricted in middle and low income countries. We sought to review the status of ART and fertility preservation in Brazil, considering social indicators and legislative issues that may hinder the universal access to these services. Although the Brazilian Constitution expressly provides the right to health, and ordinary law ensures the state is obliged to support family planning, access to services related to ART and fertility preservation is neither easy nor egalitarian in Brazil. Only a handful of public hospitals provide free ART, and their capacity far from meets demand. Health insurance does not cover ART, and the cost of private care is unaffordable to most people. Brazilian law supports, but does not command, the state provision of ART and fertility preservation to guarantee the right to family planning; therefore, the availability of state-funded treatments is still scarce, reinforcing social disparities. Economic projections suggest that including ART in the Brazilian health system is affordable and may actually become profitable to the state in the long term, not to mention the ethical imperative of recognizing infertility as a disease, with no reason to be excluded from a health system that claims to be 'universal'.

Abortion Rights after Artificial Wombs: Why Decriminalisation is Needed Ahead of Ectogenesis.

Significant scientific progress has been made toward artificial womb technology, which would allow part of human gestation to occur outside the body. Bioethical and legal scholars have argued that artificial wombs will challenge defences of abortion based in arguments for protecting bodily autonomy, for a pregnant person could have the foetus transferred to an artificial womb instead of being terminated. Drawing on examples from the common law jurisdictions of Canada, the USA, and the UK, I assess three ways scholars have argued abortion might be defended after ectogenesis (through redefining foetal viability, through a property right, and through a right to avoid genetic parenthood). I argue that while each of these proposals has strategic merit, each has significant legal and ethical limitations. Taking the normative position that abortion will remain a vital healthcare resource, I make the case for protecting abortion rights from a challenge posed by ectogenesis by focusing on decriminalisation.

Rethinking "Elective" Procedures for Women's Reproduction during Covid-19.

Common hospital and surgical center responses to the Covid-19 pandemic included curtailing "elective" procedures, which are typically determined based on implications for physical health and survival. However, in the focus solely on physical health and survival, procedures whose main benefits advance components of well-being beyond health, including self-determination, personal security, economic stability, equal respect, and creation of meaningful social relationships, have been disproportionately deprioritized. We describe how female reproduction-related procedures, including abortion, surgical sterilization, reversible contraception devices and in vitro fertilization, have been broadly categorized as "elective," a designation that fails to capture the value of these procedures or their impact on women's overall well-being. We argue that corresponding restrictions and delays of these procedures are problematically reflective of underlying structural views that marginalize women's rights and interests and therefore threaten to propagate gender injustice during the pandemic and beyond. Finally, we propose a framework for triaging reproduction-related procedures during Covid-19 that is more individualized, accounts for their significance for comprehensive well-being, and can be used to inform resumption of operations as well as subsequent restriction phases.

Procreative Non-Maleficence: A South African Human Rights Perspective on Heritable Human Genome Editing.

If the safety and efficacy issues relating to heritable genome editing can be resolved, how should liberal democratic societies regulate the use of this technology by prospective parents who wish to effect edits to the genomes of their prospective children? We suggest that recent developments in South African law can be useful in this regard. The country's apex court recently recognized as a legal principle that the scope of possible reproductive decisions that parents may make when using new reproductive technologies excludes decisions that will cause harm to the prospective child-the principle of procreative non-maleficence. We suggest that the principle of procreative non-maleficence provides a mechanism for striking an equitable balance between two competing interests that are given legal recognition in most liberal democracies: the reproductive rights of prospective parents and the state's duty to protect child welfare.

Ordo-Responsibility for Germline Gene Editing.

The case of twins born with genes modified by He Jiankui highlights the need for international governance of germline gene editing (GGE). This article proposes a global framework that utilizes "ordo-responsibilities." This is a pragmatic ethical approach open to pluralism and grounded in principles of human dignity and human rights. Ordo-responsibility is pragmatic in (1) accepting generally available values on a global level (e.g., human dignity, human rights) and (2) seeking achievable implementation. Genetic science is practiced globally in ways that transcend borders. As such, its practice must take account of the vast complexity of cultural, ethical, legal, and anthropological convictions. Here, we explain the basic structure of an appropriate rule-finding process, outline a possible pathway toward an international framework, and discuss minimal requirements that are needed in that endeavor. We thereby contribute to the debate on how to govern genome-editing technologies and GGE globally.

The problem with reproductive freedom. Procreation beyond procreators' interests.

Reproductive freedom plays a pivotal role in debates on the ethics of procreation. This moral principle protects people's interests in procreative matters and allows them discretion over whether to have children, the number of children they have and, to a certain extent, the type of children they have. Reproductive freedom's theoretical and political emphasis on people's autonomy and well-being is grounded in an individual-centred framework for discussing the ethics of procreation. It protects procreators' interests and significantly reduces the permissible grounds for interference by third parties. In this article I show that procreative decisions have far-reaching effects on the composition and size of the population. The upshot of considering these effects allows for the appreciation of the inadequacy of a framework that solely considers individual (i.e. procreators') interests to discuss the ethics of procreation. To address such inadequacy, I assess costs and benefits of past and present proposals to reflect on procreation in such a way as to consider its far-reaching effects. I conclude by arguing that reproductive freedom should be defended as an imperfect but instrumentally necessary tool. This framing would enable those participating in debates on the ethics of procreative decisions to work towards an ethical framework that accounts for the cumulative effects of these decisions.

Drawing the line on in vitro gametogenesis.

In vitro gametogenesis (IVG) might offer numerous research and clinical benefits. Some potential clinical applications of IVG, such as allowing opposite-sex couples experiencing infertility to have genetically related children, have attracted support. Others, such as enabling same-sex reproduction and solo reproduction, have attracted significantly more criticism. In this paper, we examine how different ethical principles might help us to draw lines and distinguish between ethically desirable and undesirable uses of IVG. We discuss the alleged distinction between therapeutic and non-therapeutic uses of assisted reproduction in the context of IVG, and show how it is both problematic to apply in practice and theoretically dubious. We then discuss how the ethical principles of reproductive justice and beneficence apply to IVG for opposite-sex reproduction, same-sex reproduction, and solo reproduction. We suggest that these principles generate strong reasons for the use of IVG for opposite-sex and same-sex reproduction, but not for solo reproduction.

Wrongful genetic connection: neither blood of my blood, nor flesh of my flesh.

The use of reproductive techniques and the eventual reproductive negligence from the provider of reproductive services gave rise to situations in which the intended parents are deprived of raising a child genetically connected to them. Courts have been dealing with cases of those for years, but have systemically denied claimants (the prospective parents) compensation, failing to recognise as damage the loss of genetic connection. In 2017, for the first time, the Singapore High Court provided compensation for that damage, labelled "loss of genetic affinity" (ACB v Thomson Medical Pte Ltd and Others [2017] SGCA 20). This paper will argue that the damage in question is the loss of genetic connection (wrongful genetic connection) and results from a violation of reproductive rights (and eventually also the right to found a family) because a key element of reproductive rights is to have children with whom we keep a genetic bond and raise them. The paper will explain why the arguments classically argued against such compensation are unfounded and it will argue for a compensation covering both patrimonial and non-patrimonial damages.

Sexual and reproductive rights under attack: the advance of political and moral conservatism in Brazil.

This article discusses political setbacks related to sexual and reproductive health and rights that have occurred in Brazil in the last 5 years (2014-2018) resulting from the significant role played by Christian (Evangelical and Catholic) parliamentarians in the legislative branch. Political initiatives aimed at prohibiting the affirmation of sexual and reproductive rights, while also curtailing debate about sexuality and gender in schools and universities, have raised "moral panic" within some elements of Brazilian society. The discursive strategies used around so-called "gender ideology" stimulated the formation of civil organisations which promote morality based on right-wing political positions. For this study, we looked at official documents and bibliographic material to examine how issues related to abortion rights, health care in cases of sexual violence, the prevention of sexually transmitted infections and homosexual citizenship are currently being suppressed, compromising the defence and advancement of the sexual and reproductive rights of women and the LGBTI+ population. The results point to the steady weakening of public policies that had become law in the 1980s, a time of Brazilian re-democratisation after two decades of military dictatorship. A wide range of civil, political and social rights, which saw significant growth and consolidation over the last 20 years, were rolled back after the resurgence of the extreme right wing in the federal legislature, culminating in the election of the current president in October 2018. However, social movements have increased in strength in the last few decades, especially the black feminist and LGBTI+ rights movements. These movements continue to provide political resistance, striving to affirm and protect all sexual and reproductive rights achieved to date.

Upsetting the balance on sex selection.

It is widely assumed that the strongest case for permitting non-medical sex selection is where parents aim at family balance. This piece criticizes one representative attempt to justify sex selection for family balance. Kluge (2007) assumes that some couples may seek sex selection because they hold discriminatory values, but this need not impugn those who merely have preferences, without evaluative commitments, for a particular sex. This is disputed by those who see any sex selection as inherently sexist because it upholds stereotypes about the sexes. This article takes an alternative approach. I argue that, even if we accept that preference-based selection is unobjectionable, a policy permitting selection for family balancing does a poor job of distinguishing between value-based and preference-based selection. If we wish to permit only preference-based sex selection we should seek to identify parents' motives. If we wish to justify a family balancing policy, other arguments are needed.

[Critical analysis on the evolution of ethical norms for the use of assisted reproduction techniques in Brazil]. / Análise crítica sobre a evolução das normas éticas para a utilização das técnicas de reprodução assistida no Brasil.

The Federal Medical Council (FMC) published FMC Resolution No. 1,358/1992 with the aim of adopting ethical standards for the use of Assisted Reproduction Techniques (ART). This resolution was updated in 2010 (CFM No. 1957/2010), in 2013 (CFM No. 2,013/13) and the last update was in 2015 (CFM No. 2.121/2015). The scope of this article is to conduct a critical analysis of the evolution of the ethical norms proposed by FMC for the use of ART in Brazil. A documentary analysis of the text of the four published Resolutions was carried out, in which the ethical standards for the use of ART were described. It was observed that the resolution evolved in relation to the rights of homosexuals, adopted more permissive measures regarding cryopreservation, donation of gametes and embryos and uteruses on loan and lastly authorized some procedures in ART such as postmortem reproduction, donation and shared gestation. From 2013 onwards the resolution gained a liberal character being updated in terms of clinical practice. For the next updates it would be interesting to include procedures in ART not previously addressed such as nuclear and cytoplasmic transfer. The update frequency (every two years) should be kept to the ethical standards enabling the ART to continue evolving together with the advancement of science.

O Conselho Federal de Medicina (CFM) publicou em 1992 a resolução CFM nº 1.358/1992 com o objetivo de adotar normas éticas para utilização das técnicas de Reprodução Assistida (TRA). Esta resolução foi atualizada em 2010 (CFM nº 1.957/2010), em 2013 (CFM Nº 2.013/13) e teve sua última atualização 2015 (CFM nº 2.121/2015). O objetivo desse artigo é fazer uma análise crítica sobre a evolução das normas éticas propostas pelo CFM para a utilização de TRA no Brasil. Foi realizada uma análise documental do texto das quatro Resoluções publicadas onde estão descritas as normas éticas para utilização das TRA. Foi observado que a resolução evoluiu em relação aos direitos dos homossexuais, adotou medidas mais permissivas em relação a criopreservação, doação de gametas e embriões e cessão de útero e por fim autorizou alguns procedimentos em TRA como a reprodução post mortem, doação e gestação compartilhada. A partir de 2013 a resolução ganhou um caráter liberal estando atualizada com a prática clínica. Para as próximas atualizações seria interessante incluir procedimentos em TRA os quais não foram abordados como a transferência nuclear e citoplasmática. A frequência de atualização (a cada dois anos) deve ser mantida para as normas éticas que norteiam a TRA continuar evoluindo juntamente com o avanço da ciência.