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1.
Soins Pediatr Pueric ; 40(311): 12-17, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31757269

RESUMO

Medically assisted reproduction techniques are aimed at heterosexual couples, when both members are living, of reproductive age, consenting to acts of insemination or the transfer of embryos and presenting medically diagnosed infertility. The review of the law on bioethics could offer new perspectives for reproduction notably by allowing access to medically assisted reproduction (MAR) to all women, elective egg freezing, the lifting of gamete donor anonymity and the authorisation of post-mortem MAR.


Assuntos
Bioética , Infertilidade , Técnicas de Reprodução Assistida , Feminino , Humanos , Técnicas de Reprodução Assistida/ética
2.
Am J Law Med ; 45(2-3): 130-170, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31722626

RESUMO

In many areas of innovation, the United States is a leader, but this characterization does not apply to the United States' position in assisted reproductive technology innovation and clinical use. This article uses a political science concept, the idea of the "democratic deficit" to examine the lack of American public discourse on innovations in ART. In doing so, the article focuses on America's missing public consultation in health care innovation. This missing discourse is significant, as political and ethical considerations may impact regulatory decisions. Thus, to the extent that these considerations are influencing the decisions of federal agency employees, namely those who work within the U.S. Food and Drug Administration, the public is unable to participate in the decision-making process. This lack of a public discourse undermines the goals of the administrative state, which include democratic participation, transparency, and accountability. The United Kingdom, on the other hand, has had a markedly divergent experience with assisted reproductive technology innovation. Instead of ignoring the various ethical, social, and legal issues surrounding assisted reproductive technology innovation, the United Kingdom engaged in a five-strand public consultation on the topic of mitochondrial transfer, a form of assisted reproductive technology that uses genetic modification in order to prevent disease transmission. This article argues that after a multi-decade standstill in terms of the public discourse related to ethical issues associated with assisted reproductive technology and germline modification, it is time for the United States to institute a more democratic inquiry into the scientific, ethical, and social implications of new forms of assisted reproductive technology and ultimately, forthcoming medical innovations that involve genetic modification.


Assuntos
Democracia , Invenções/legislação & jurisprudência , Formulação de Políticas , Técnicas de Reprodução Assistida/legislação & jurisprudência , Participação da Comunidade , Governo Federal , Fertilização In Vitro/ética , Fertilização In Vitro/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Humanos , Invenções/ética , Técnicas de Reprodução Assistida/ética , Responsabilidade Social , Participação dos Interessados , Governo Estadual , Inquéritos e Questionários , Reino Unido , Estados Unidos , United States Food and Drug Administration/legislação & jurisprudência
4.
New Bioeth ; 25(2): 121-136, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31130115

RESUMO

The advantages and risks of a number of new genome modifying procedures seeking to create healthy or enhanced individuals, such as Maternal Spindle Transfer, Pronuclear Transfer, Cytoplasmic Transfer and Genome Editing, are currently being assessed from an ethical perspective, by national and international policy organizations. One important aspect being examined concerns the effects of these procedures on different kinds of identity. In other words, whether or not a procedure only modifies the qualities or properties of an existing human being, meaning that merely the qualitative identity of this single individual is affected, or whether a procedure results in the creation of a new individual, meaning that a numerically distinct human being would have come into existence. In this article, the different identity arguments proposed, so far, are presented with respect to these novel reproductive procedures. An alternative view is then developed using the Origin Essentialism argument to indicate that any change in the creative conditions of an individual such as in his or her biology but also the moment in time, and the three dimensions of space, will have a numerical identity effect and bring into existence a new individual who would not, otherwise, have existed. Because of this, it is concluded that a form of selection may have taken place in which a preference was expressed for one new possible individual instead of another, based on some frame of reference. This may then mean that a selection between persons has occured  contravening the European Union Charter of Fundamental Rights which was ratified in 2000.


Assuntos
Edição de Genes/ética , Terapia de Substituição Mitocondrial/ética , Técnicas de Reprodução Assistida/ética , Melhoramento Genético/ética , Perfil Genético , Terapia Genética/ética , Humanos
5.
Med Sci (Paris) ; 35(4): 356-363, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-31038114

RESUMO

This contribution aims at analysing and presenting a comparative dimension concerning the issues raised for the upcoming French Bioethics law revision in the field of assisted reproductive technologies (ART) : access of female same-sex couples and single women to ART ; the authorization of post-mortem procreation ; enlarging eligibility criteria for oocyte self-conservation ; and lifting the anonymity of gamete donation. These questions touch at the very heart of the French bioethics model conceived in 1994, and their revision would constitute a conceptual upheaval.


Assuntos
Temas Bioéticos , Técnicas de Reprodução Assistida/ética , Técnicas de Reprodução Assistida/legislação & jurisprudência , Anônimos e Pseudônimos , Bioética/tendências , Feminino , Preservação da Fertilidade/ética , Preservação da Fertilidade/legislação & jurisprudência , Humanos , Infertilidade Feminina/psicologia , Infertilidade Feminina/terapia , Casamento , Doação de Oócitos/ética , Doação de Oócitos/legislação & jurisprudência , Concepção Póstuma/ética , Concepção Póstuma/legislação & jurisprudência , Técnicas de Reprodução Assistida/normas , Técnicas de Reprodução Assistida/tendências , Minorias Sexuais e de Gênero/legislação & jurisprudência , Pessoa Solteira/legislação & jurisprudência
9.
Cien Saude Colet ; 24(3): 917-928, 2019 Mar.
Artigo em Português | MEDLINE | ID: mdl-30892513

RESUMO

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.


Assuntos
Bioética , Direitos Sexuais e Reprodutivos/ética , Técnicas de Reprodução Assistida/ética , Brasil , Criopreservação/ética , Direitos Humanos/legislação & jurisprudência , Humanos , Direitos Sexuais e Reprodutivos/legislação & jurisprudência , Técnicas de Reprodução Assistida/legislação & jurisprudência , Minorias Sexuais e de Gênero/legislação & jurisprudência , Doadores de Tecidos/ética
11.
Fertil Steril ; 111(4): 659-663, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30871767

RESUMO

The Ethics Committee recommends that in vitro fertilization (IVF) centers develop patient-centered policies regarding requests for futile treatment. In most cases, clear communication can avoid a direct conflict, but clinicians ethically may refuse to provide treatment believed to be futile or to carry a very poor prognosis. In certain instances, clinicians may provide limited treatment which they judge likely to be futile, but must be vigilant in their presentation of risks, benefits, and alternatives. This version replaces the previous published draft of this name (Fertil Steril 2012;98:e6-9).


Assuntos
Infertilidade/diagnóstico , Infertilidade/terapia , Futilidade Médica , Técnicas de Reprodução Assistida/ética , Comissão de Ética , Prova Pericial , Feminino , Humanos , Futilidade Médica/ética , Gravidez , Prognóstico , Fatores de Risco
12.
Br Med Bull ; 129(1): 5-11, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30753441

RESUMO

INTRODUCTION: Artificial gametes (AGs) are cells that have been 'reprogrammed' to function as sperm or eggs. Such cells may in the future enable people who cannot produce gametes, to have genetically-related offspring. In this paper, I consider the prospect of AGs in the context of declining birthrates and postponed parenthood across the Western world. SOURCES OF DATA: The data quoted in this paper is gathered from a range of sources, encompassing both scientific, demographic and philosophical work. AREAS OF AGREEMENT: Fertility decline in Western democracies is a widely recognised phenomenon, and postponement of parenthood is regarded as a significant contributing factor in this phenomenon. AREAS OF CONTROVERSY: It is not clear at what point, if ever, AGs might come into clinical use. There is dispute as to what is the best approach to declining fertility rates in developed countries. GROWING POINTS: Technologically-assisted reproduction is becoming a more common phenomenon as fertility rates fall and maternal age increases. AGs could offer new ways in which to prolong fertility. AREAS TIMELY FOR DEVELOPING RESEARCH: More research into the development of AGs is required. There is a need for close analysis of the possible causes of declining fertility and the ways in which societies might respond to these challenges.


Assuntos
Células Germinativas , Infertilidade/terapia , Técnicas de Reprodução Assistida , Coeficiente de Natalidade , Ética Médica , Humanos , Idade Materna , Técnicas de Reprodução Assistida/ética
13.
Gac Med Mex ; 155(1): 3-14, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-30799447

RESUMO

The use of donated gametes and embryos in assisted reproduction techniques (ART) makes it necessary to examine interests that involve relevant ethical and legal considerations, which include the autonomy and privacy rights of the intended parents, donors' right to privacy and the right of the minors to know their genetic origin. This article presents arguments to consider policies of more openness to obtain information from donors in order to protect the child's best interest in knowing his/her genetic origins. It concludes with the situation in Mexico, where ART has been carried out with donated gametes since several years ago; however, due to the absence of regulations to control these procedures, each establishment imposes its own criteria for the operation of its programs.


Assuntos
Confidencialidade/legislação & jurisprudência , Técnicas de Reprodução Assistida/legislação & jurisprudência , Doadores de Tecidos/legislação & jurisprudência , Acesso à Informação/ética , Acesso à Informação/legislação & jurisprudência , Confidencialidade/ética , Destinação do Embrião/ética , Destinação do Embrião/legislação & jurisprudência , Feminino , Células Germinativas , Humanos , Masculino , México , Doação de Oócitos/ética , Doação de Oócitos/legislação & jurisprudência , Técnicas de Reprodução Assistida/ética , Doadores de Tecidos/ética
14.
Med Health Care Philos ; 22(3): 487-495, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30758798

RESUMO

People who are involuntarily childless need to use assisted reproductive technologies if they want to have a genetically related child. Yet, from an ethical point of view it is unclear to what extent assistance to satisfy this specific desire should be warranted. We first show that the subjectively felt harm due to the inability to satisfy this reproductive desire does not in itself entail the normative conclusion that it has to be met. In response, we evaluate the alternative view according to which the satisfaction of this desire is regarded as a way to meet one's presumed intermediate need for parenthood. This view presupposes that parenthood is one of those general categories of experiences and activities that contribute an irreplaceable value to people's lives, but the central difficulty is to find those characteristics that mark out parenthood as an irreplaceable constituent of a valuable life. We go on to argue, however, that even if one assumes that parenthood is such an irreplaceable constituent that makes life more valuable, this does not necessarily entail a moral duty to satisfy the desire for genetic parenthood. We conclude that there is a pro tanto obligation to help people conceive a genetically related child (if this is what they prefer), but that this can be outweighed by other moral considerations, such as safety and justice concerns.


Assuntos
Relações Pais-Filho , Pais/psicologia , Linhagem , Técnicas de Reprodução Assistida , Família/psicologia , Humanos , Casamento/psicologia , Técnicas de Reprodução Assistida/ética , Técnicas de Reprodução Assistida/psicologia
15.
J Bioeth Inq ; 16(3): 333-345, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30715660

RESUMO

Maqasid al-Shariah based Islamic bioethics is an Islamic bioethics concept which uses the objectives of the Shariah (maqasid al-Shariah) as its approach in analysing and assessing bioethical issues. Analysis based on maqasid al-Shariah based Islamic bioethics will examine any bioethical issues from three main aspects namely intention, method, and output or final goal of the studied issues. Then, the evaluation will be analysed from human interest hierarchy, inclusivity, and degree of certainty. The Islamic bioethics concept is a manifestation of dynamic Islamic jurisprudence which can overcome new complex and complicated bioethical issues such as tri-parent baby technology issues. Therefore, this article will introduce and explain the concept of maqasid al-Shariah based Islamic bioethics and outline a general guidance of maqasid al-Shariah based Islamic bioethics to determine a maqsad (objective) based on standards of human good or well-being (maslahah) and harm (mafsadah).


Assuntos
Temas Bioéticos/legislação & jurisprudência , Bioética , Islamismo , Avaliação da Tecnologia Biomédica/ética , Princípios Morais , Religião e Medicina , Técnicas de Reprodução Assistida/ética , Responsabilidade Social
18.
Med Law Rev ; 27(3): 365-389, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30690476

RESUMO

Australian medical professionals whose patients undertake assisted reproductive treatment abroad face a conflict: to try to provide optimal and on-going care for their patient at the same time as ensuring compliance with Australian legal, ethical, and professional rules which proscribe as unsafe or unethical key aspects of such treatment. A major suggestion from literature on medical travel is that risks to the patient can be mitigated through the involvement of the local professional. However, the force of legal regulation and ethical guidance in Australia strenuously directs clinicians away from involvement in overseas reproductive treatment. This article reports on 37 interviews with Australians travelling abroad for surrogacy, egg donation, and embryo donation, reflecting on patients' experiences with Australian medical professionals both before and after they travelled. Patient reports demonstrate a fragmented and bewildering medical landscape in Australia, in which the ability to access domestic care and expertise varied markedly depending upon the kind of treatment patients were seeking abroad, and the mode of practice of the Australian doctor. Doctors practicing within licensed IVF clinics were notably more constrained than those outside such a setting. Patients seeking egg donation were offered information and received a wide range of diagnostic and preparatory treatments, while those seeking surrogacy were shunned, chided and offered limited (and sometimes covert) assistance. While recent changes to national ethical guidance improve clarity on information giving, the ethical and legal propriety of Australian medical professionals providing diagnostic or preparatory treatment for cross border reproduction remains uncertain.


Assuntos
Ética Profissional , Pessoal de Saúde/ética , Pessoal de Saúde/legislação & jurisprudência , Turismo Médico/ética , Turismo Médico/legislação & jurisprudência , Técnicas de Reprodução Assistida/ética , Técnicas de Reprodução Assistida/legislação & jurisprudência , Adulto , Austrália , Continuidade da Assistência ao Paciente , Feminino , Guias como Assunto , Redução do Dano , Humanos , Entrevistas como Assunto , Masculino , Turismo Médico/normas , Gravidez , Técnicas de Reprodução Assistida/normas
19.
BJOG ; 126(2): 237-243, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30548407

RESUMO

Over 8 million babies have been born following IVF (in vitro fertilisation) and other artificial reproductive technology (ART) procedures since Louise Brown's birth 40 years ago. New innovations have added much complexity to both clinical and laboratory procedures over the last four decades. Translation of novel approaches from basic science into clinical practice continues unabated, widening the applicability of ART to new groups of people and helping improve both chances of healthy live birth and patient acceptability. However, the impact of ART on the health of both patients and their offspring continues to cause concern, and many ethical challenges created by new scientific developments in this field attract widely differing opinions. What is undeniable is that there will be a sustained global growth in utilisation of ART and that reproductive tourism will allow many people to access the treatment they desire notwithstanding national regulations that may forbid some approaches. The greatest challenge is to expand access to ART to those living in the less wealthy nations who are equally deserving of its benefits.


Assuntos
Técnicas de Reprodução Assistida/tendências , Injeções de Esperma Intracitoplásmicas/tendências , Feminino , Fertilização In Vitro/tendências , Humanos , Masculino , Gravidez , Comportamento Reprodutivo , Técnicas de Reprodução Assistida/economia , Técnicas de Reprodução Assistida/ética
20.
Bioethics ; 33(1): 60-67, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30136749

RESUMO

This paper explores whether egg donation could still be ethically justified if in vitro gametogenesis (IVG) became reliable and safe. In order to do this, issues and concerns that might inform a patient's reasoning in choosing to use donor eggs instead of IVG are explored and assessed. It is concluded that egg donation would only be ethically justified in a narrow range of special cases given the (hypothetical) availability of IVG treatment and, further, that egg donation could itself be replaced by donation through IVG techniques. Two possible criticisms of this position are then considered: Ones based on respect for patient wishes, and on loss of donor benefit. It is concluded that whilst neither argument constitutes a strong enough reason to continue with programmes of egg donation, egg-sharing programmes could still be permitted come the advent of IVG; these could then provide a morally acceptable source of "natural" donor eggs.


Assuntos
Dissidências e Disputas , Ovos , Engenharia Genética/ética , Oogênese , Reprodução/ética , Técnicas de Reprodução Assistida/ética , Adulto , Criança , Comportamento de Escolha , Feminino , Gametogênese , Humanos , Mães , Direitos do Paciente , Reprodução/genética , Pesquisa com Células-Tronco , Células-Tronco , Doadores de Tecidos/ética , Obtenção de Tecidos e Órgãos
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