What Are the Main Legal and Ethical Issues Surrounding Assisted Reproduction

Pennings G, Mertes H: Ethical Issues in the Treatment of Infertility. Best Pract Res Clin Obstet Gynaecol 2012; 26: 853–863. If genetic risks are related to the cause of infertility, genetic counseling is always necessary. Usually, the etiology of infertility is diagnosed in the infertility clinic. If the cause is genetic and there are possible consequences for the offspring, the couple should be referred for genetic counseling. The cause itself is explained and the effects on the person`s close relatives (e.g. siblings) are also discussed. The couple may feel that they need help informing their loved ones if necessary: this can usually be provided by genetic health professionals. The couple may be reluctant to discuss these issues during current treatment, in which case the interview may be scheduled for later. Situations in which genetic counseling should always be extended to the family, at least to siblings in the index case, include chromosomal translocations and certain diseases leading to female infertility (e.g.

ovarian dysfunction in carriers of FMR1 premutation) or male infertility (especially CFTR mutations/variants leading to CBAVD; see above), in which first-degree relatives are particularly at risk. having the same problem and/or their illness can have serious and unexpected consequences. for their offspring. These issues are more complicated when using genome-wide diagnostic tests such as the currently used aCGH.112 To distinguish between the use and misuse of ART, we must first understand the basic ethical basis on which the “treatment” of ART is accepted by society in the first place. Why do we undertake ART and what are our ethical and social justifications? The reasons for CBRC vary, but are more often due to legal restrictions where at least some techniques are prohibited for all populations or for some of them, such as single women or same-sex couples. Other reasons include restrictions on access to the home, including the availability of a certain technique, long waiting lists or age limits (for example, in the UK there is no national health treatment for women over 40, while in France government reimbursements are available until the age of 43) looking for better or cheaper treatment abroad. as well as previous failures at home. There are no ethical objections to CBRC per se, as it strengthens patient autonomy and also respects the principle of free movement of patients and expertise within the EU.35 Other ethical issues mainly concern the possibility of coercion and abuse of gamete donors (especially egg donors), although in Europe, The compensation for the donation must not be disproportionate. to the extent that it becomes a payment. according to EUTCD (see section “European Directives”).

59. Mustapha Z. The Practice of Assisted Reproductive Technologies (Art) in Nigeria: Unanswered Legal and Ethical Questions. J Law Judicial System 2018;1(1):40–50. 7. Kissin DM, Jamieson DJ, Barfield WD. Monitor the health outcomes of assisted reproductive technology. 2014;371(1):91–93.

doi:10.1056/NEJMc1404371 Blyth E, Thorn P, Wischmann T: CBRC and psychosocial counselling: assessing needs and developing an ethical framework for practice. Reprod Biomed Online 2011; 23: 642–651. Another area at the intersection of assisted reproduction and genetics is gamete donor selection, as recently reviewed, for example, by the practice committee of the American Society for Reproductive Medicine.277 As more and more diseases with a strong genetic component are identified and the technical capacity to detect them increases, Current guidelines for genetic testing of donors will be revised. 278 Case reports of serious genetic disorders Occasional detections in donors or former donors also lead to calls for prolonged screening.279 However, it is still unclear how far we might go in genetic screening of potential donors. It is clear that a “zero risk” approach is unrealistic and will inevitably lead to false insurance of beneficiaries. As this would lead to the exclusion of most, if not all, donors, such an approach would be counterproductive and disproportionate. The relevant ethical issues concern not only the interests of the intended parents and the future child, but also those of the donor. For example, with the prospect of large-scale screening based on genome sequencing techniques, there is a risk of predicting discoveries of disorders that the donor (and close relatives) might perceive as a threat without meaningful options.280 Respect for autonomy would require donors to be informed of the potential impact of testing on both themselves and their close relatives. A specific issue concerns the possibility of granting a genuine “right not to know”. Genetic and reproductive counselling should be offered to pre-screened donors. Donors should not be excluded due to heterozygosity in rare autosomal recessive (“Mendelian”) diseases, as they can be assigned to appropriate recipients. In this case, however, the cost of additional genetic testing can play a disabling role.

Although antiretroviral therapy is almost always associated with problems that require genetic screening or testing, genetic counseling is not always necessary.