Future Choices: Assisted Reproductive Technologies and the Law

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Section 1: Insurance coverage for infertility treatments

Section 2: Disposal of frozen embryos

Section 3: Determination of parentage

Appendix: Comprehensive Guide to State Surrogacy Laws

Glossary

Event information and video

Introduction and summary

In our modern world, sex is no longer the exclusive method for humans to reproduce. A new group of medical options, known as “assisted reproductive technologies,” challenge our understanding of parenthood and biological relationships.

Louise Brown, the world’s first “test tube baby” was born in 1978. Since then, the field of assisted reproduction has taken off, bringing ever more new and innovative ways of creating children, as well as family relationships. increasingly complex and ethically heavy. medical practices.

The relationship between technology and the law in this context is symbiotic. If we think of new technologies as plants, growing skyward and leading us into new medical, scientific and ethical fields, then the legal ground is the soil, dictating which practices can develop and prosper and which must wither. Every decision to regulate or not creates unique incentives and disincentives for the fertility industry and those it serves.

For now, the fertility industry remains largely unregulated in the United States. Where the regulation of these technologies has taken place, however, it has had concrete consequences for thousands of people and spillover effects across multiple areas of law, from adoption to abortion, insurance. – inheritance disease.

While some states have passed laws that indirectly affect the practices of fertility clinics, legislatures and courts have focused more on the ramifications of these procedures. Who are the legal parents of a child who was created through the efforts of five people: two genetic donors, a gestational mother and two “intended” parents who started it all? In a dispute over the custody of a frozen embryo, which principles of law should apply: ownership, contract, family, constitutionality or a combination of the two?

Assisted reproductive technologies bring to the fore important questions about who we are as individuals and families and who society believes has the right to reproduce and parent.

Assisted reproductive technologies bring to the fore important questions about who we are as individuals and families and to whom society believes have the right to reproduce and parent. And these questions will not go away. While some might like to stop the stopwatch so they can set the ground rules, others just keep playing.

Latest example: In January 2007, a team of doctors announced their intention to undertake the first uterine transplant in the United States.2 Almost every day, a story comes out about new technologies and their impact on the families who have them. used.

Those looking to use these technologies include those who are infertile for both medical and social or situational reasons. Medical infertility affects about 10 percent of the population of childbearing age — about 7.3 million people — and strikes people from all socioeconomic backgrounds. Infertility affects both men and women equally: men and women each account for 35 percent of infertility cases, 20 percent of cases result from combined problems in women and men, and in 10 percent of cases of infertility. case, the cause of infertility cannot be identified. Although age can be a factor in infertility, sexually transmitted infections, exposure to certain chemicals, tobacco and alcohol consumption, and excessive weight gain or loss are also factors. risk of infertility.

In addition to those who face physiological barriers to conceiving or maintaining a pregnancy, those who are physically able to reproduce but do not have an opposite-sex partner to reproduce with are increasingly benefiting from assisted reproduction services. They include lesbian, gay and transgender couples as well as singles of any sexual orientation or gender identity.

Where people line up along the political spectrum in their views on assisted reproductive technologies, this is not always where one would expect. A curator who previously believed that life begins at conception may decide that it does not begin until implantation after he and his wife choose to undergo in vitro fertilization. A progressive who ardently defends the right to abort for any reason may not believe that there is a right to screen for and discard embryos that have undesirable characteristics.

The conflicts described throughout this article reveal the painful and emotionally charged controversies that can arise when assisted reproduction devices do not go as planned. But as a political issue, assisted reproduction technologies provide our society with the opportunity to have thoughtful and respectful debates on a range of critical issues, from how we define family to when we think human life begins – deeply felt beliefs that in other contexts have proven to be quite volatile and polarizing.

Given the novelty of assisted reproduction technologies and the lack of firm positions on which services should be permitted or prohibited and under what circumstances, it is hoped that the discussion in this context can be civil and productive. , maybe even change the way we think about our more steadfast positions and help us better understand the views of others on more familiar political issues.

The questions on assisted reproduction come at a time when various groups within the progressive movement are making a concerted effort to work together on issues of common interest and speak with a more united voice on the pressing issues of the day. All members of the progressive movement have an interest in knowing what types of assisted reproduction technologies are available, to whom they are available and how they are used, especially the reproductive rights, health and justice community; the LGBT community (lesbian, gay, bisexual, transgender); the disability rights community; the environmental community; and economic, racial and social justice communities. It is essential that groups that focus on these issues begin to address assisted reproduction in their work.

Ultimately, Americans from all perspectives will be challenged by the questions raised by assisted reproductive technologies. To that end, the Center for American Progress has prepared this report so that people can familiarize themselves with some of these technologies, understand how the law has evolved in this area so far, and ask how we want to proceed in the future.

We see this work as a natural continuation of our article, “More than a Choice: A Progressive Vision for Reproductive Health and Rights”. In this article, we have discussed a very comprehensive program, which included caveats and ambitious goals regarding assisted reproduction. We hope that “Future Choices” will lay the groundwork for the progressive movement to make difficult but essential decisions on how to move forward in this complicated area.

Since progressivism embodies openness to change, a healthy respect for facts and nuanced arguments, and a search for pragmatic solutions, the progressive movement can lead the way in forging just policies regarding these new ways of creating families. As we seek to answer the many questions raised by the few laws governing assisted human reproduction, it may be helpful to keep in mind the following progressive values:

  • Right to privacy
  • Freedom of procreation
  • Social justice
  • The health and well-being of women and children
  • Gender equality
  • Equal opportunities for parenthood by people from all walks of life
  • Equitable access to health care
  • Respect for moral and autonomous personal decisions
  • Cautious optimism about scientific progress
  • Respect for biological and genetic diversity
  • Evidence-Based Policy Development

The political decisions that we must make are difficult and can reveal tensions between our sometimes competing interests, but the process of shaping our positions should ultimately help us to clarify our values ​​and priorities, to strengthen the progressive movement in as a whole and, above all, to improve people’s lives. . In this article, we first give a basic overview of assisted reproduction. Next, we tackle three main areas in which lawmakers and courts have already spoken to some extent – health insurance coverage, embryo disposition, and parentage determinations – and examine the policy implications their decisions create. .

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