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[Above what limits is ART of no avail?].

Legal limits to assisted reproduction technologies are rather blurred. The law of July 1994 only says that people must be "in age of procreation"; medical opposable reference only says that infertility exploration must begin before 45 years. The guide of good practice in ART writes that over 37 only women with normal ovarian reserve must be included in ART programs. So physicians have to fix their own limits, according to success rate and this limit is often 42-43 years for women.

Adult↗

Reproductive rights in Hungarian law: a new right to assisted procreation?

Hungary has a mixed record in terms of fulfilling reproductive rights as a whole, but in the context of artificially assisted procreation, it provides reproductive health services far beyond those offered by its neighbors, beyond what is stipulated by the ICPD Programme of Action, and, arguably, beyond the internationally accepted parameters of reproductive rights. Recent legislation on assisted procreation has established important new regulations and formulated a new "right to continuation of infertility treatment" applicable to women who have been widowed or divorced. The new legislation is examined in the context of the international reproductive rights movement, with comparisons to other European countries and with reference to Hungarian attitudes and laws on abortion and surrogacy.

Abortion, Legal↗

Plundered kitchens and empty wombs: fear of infertility in the Cameroonian grassfields.

In Bangangté, a Bamiléké kingdom in the Grassfields of Cameroon, local understandings of reproductive illness contrast with standard demographic indicators of high fertility in this region. Bangangté are preoccupied with threats to reproductive health. This article explores the culinary metaphors of building kitchens, choosing, measuring, and mixing ingredients, and slow and skillful cooking in Bangangté notions of procreation and infertility. The violent imagery of plundered kitchens, cannibalistic witchcraft, and theft permeates Bangangté women's accounts of infertility and child loss. The analysis suggests that infertility anxiety in Bangangté reflects women's feelings of vulnerability in the context of rural female poverty and the gender-specific consequences of political change in Cameroon.

Agriculture↗

[Medico-administrative aspects of medically assisted reproduction techniques].

Artificial procreation techniques raise many ethical questions. The National Consultative Ethics Committee has pronounced on two occasions on this subject. Apart from ethical considerations, the rapid development of various techniques has required regulations aimed at ensuring the quality of the medical activities performed. The decree of April 8, 1988 concerning medically assisted procreation limits the practice of these activities to hospitals and medical biology laboratories. These regulations do not apply to fundamental questions which fall in the realm of legislation. A bill has already been drafted; if it passes it might provide a few guiding marks on this subject for practitioners and for society as a whole.

Ethics, Medical↗

Genetically defective children: emerging legal considerations.

Despite modern medical advances, births of genetically defective children still occur. The author outlines the problem of genetic disease, and describes the medical and legal advances that now make possible a reduction in its incidence. Then she cites--and briefly comments upon--some court cases brought by parents of genetically defective children against their physicians for allegedly failing to predict or to diagnose genetic defects in those children in time for the parents to exercise any procreative options such as sterilization, contraception, or abortion. In addition, the author speculates on various questions that may arise in future litigation in this area--among them, the question of whether or not courts someday will endow genetically defective children with a cause of action against their parents for bringing them into the world.

Child↗

Procreative beneficence: why we should select the best children.

Eugenic selection of embryos is now possible by employing in vitro fertilization (IVF) and preimplantation genetic diagnosis (PGD). While PGD is currently being employed for the purposes of detecting chromosomal abnormalities or inherited genetic abnormalities, it could in principle be used to test any genetic trait such as hair colour or eye colour. Genetic research is rapidly progressing into the genetic basis of complex traits like intelligence and a gene has been identified for criminal behaviour in one family. Once the decision to have IVF is made, PGD has few 'costs' to couples, and people would be more inclined to use it to select less serious medical traits, such as a lower risk of developing Alzheimer Disease, or even for non-medical traits. PGD has already been used to select embryos of a desired gender in the absence of any history of sex-linked genetic disease. I will argue that: (1) some non-disease genes affect the likelihood of us leading the best life; (2) we have a reason to use information which is available about such genes in our reproductive decision-making; (3) couples should select embryos or fetuses which are most likely to have the best life, based on available genetic information, including information about non-disease genes. I will also argue that we should allow selection for non-disease genes even if this maintains or increases social inequality. I will focus on genes for intelligence and sex selection. I will defend a principle which I call Procreative Beneficence: couples (or single reproducers) should select the child, of the possible children they could have, who is expected to have the best life, or at least as good a life as the others, based on the relevant, available information.

Beneficence↗

The role of an early-life variant of the oedipus complex in motivating religious endeavors.

A close reading of sources Freud used in writing Totem and Taboo supports the thesis that a predecessor archaic oedipus complex is instrumental in motivating religious worship. This early-life complex manifests a psychodynamic in which birth, growth, and self-realization, to varying degree in each individual, tend to be psychically correlated with diminution and harm vis-à-vis one's procreators. As a result, the psychodynamic is likely to induce unease over youth exercising its powers. The story of Adam and Eve, which depicts a growing self-determination being stymied and coming to grief, is a mythic epitome of this psychodynamic. Religious practices serve to expiate the sense of unease, partly by replenishing and even recasting seemingly diminished procreators, through myth and ritual, into omnipotent, immortal entities, and partly by reversing individuation's challenge to authority by exhorting submission to, and even union, with the divine parent. The sources used in demonstrating the various means whereby religious practices serve to ameliorate the burden of "original sin" include W. R. Smith (1894), the Old Testament, and studies of archaic religious rites, including those of the Aztecs.

Child↗

Gamete retrieval in terminal conditions: is it practical? What are the consequences?

There is an increasing interest in, and request for, gamete retrieval from recently deceased or near-dead subjects for the purpose of posthumous procreation. This usually arises in an emergency situation with little time for physicians to consider ethical ramifications. Advance planning is needed to help these physicians make thoughtful decisions. After considering the complexity of the issues involved, the Ethics Consult Service and the Ethics Committee at the University of Virginia requested that we develop a policy on gamete retrieval for subjects in terminal conditions, which would govern and guide involved providers should this process be requested. Our team consisted of members of the Ethics Consult Service and Ethics Committee, as well as personnel who might be intimately involved in the gamete retrieval process, including the director of the Human Gamete and Embryo Laboratory, a urologist, and a reproductive endocrinologist. In addition to reviewing the current literature describing the actual processes involved, we explored the ethical implications of gamete retrieval in these situations. A policy was developed and approved by the Ethics Committee at our institution, and is included in this article.

Academic Medical Centers↗

On the utility of statistical modelling in reproductive studies.

The usefulness of mathematical modelling is discussed, with reference to a beta-binomial model which is used to describe both the implantation and birth statistics after assisted procreation. The relatively heavy computing effort required is emphasized, and contrasted with the rather simpler calculations associated with traditional statistical methods. The advantages of deriving a concise description of the data with a few important, and easily interpretable, parameters are also discussed. Numerical data provided by an IVF clinic are used to illustrate the mathematical procedures and to provide an assessment of the success of the modelling exercise.

Female↗

[Preservation of potency by supra-ampullar cystectomy in patients with bladder neoplasms].

Between May 1984 and November 1998 a total of 27 consecutive patients with bladder tumor (26 transitional cell carcinomas and 1 leiomyosarcoma) underwent supra-ampullar cystectomy and ileal orthotopic neobladder (2 Camey I and 25 Camey II). Mean patients age was 51.1 years (range 23-65). Pre-operatively 22 patients had superficial bladder carcinoma. An involvement of prostatic urethra was excluded by biopsy. The bladder, part of the prostate with prostatic urethra and regional lymph nodes were removed while was deferens, deferential ampullae, seminal vesicles, ejaculatory ducts and peripheral portion of the prostate were saved. Mean follow-up was 56.5 months (range 4-178). One patient was lost to follow-up at 60 months. Of the 27 patients 6 died of bladder cancer (1 with local relapse, 1 with local and distant recurrence and 5 with metastases) and the remaining 21 had neither local nor distant relapse. Four patients died of other causes. Potency was preserved in 25 patients (92.5%) who reported satisfactory sexual intercourse. Sixteen patients (59.2%) also maintained ejaculation allowing procreation in two of them. Supra-ampullar cystectomy provides good results in term of quality of life allowing to preserve sexual function in nearly all the cases without compromise the control of the neoplastic disease. The indication must be restricted to bladder cancer without risk of local recurrence and concomitant prostatic carcinoma.

Adult↗

[Evaluation of health status in participants from a methadone treatment program in Krakow after one year of maintenance treatment].

Methadone treatment programme for 50 opiate addicts has been conducted at the Department of Clinical Toxicology for a one year. The aim of the study was to evaluate the health state including psychological condition and also a social status of the opiate dependent patients after one year methadone maintenance medication. Also, considering the results of clinical examination, a trial of elaboration of system for dependence scoring was undertaken. An improvement of general health state of addicts was observed. No new cases of HIV positive patients were noted. An increase in number of addicts who start professional activity, and those who live in procreative families and even in formally confirmed marriage. A three pregnant women, and five who already gave birth to a child (one of them is completely drug free at present) were noted. A significant behavioural changes, reduced level of criminal activity and restored personal relationships with family were observed. A moderate psychopathological symptoms are still observed in patients with double diagnosis.

Adult↗

[Assisted reproduction and viral hepatitis: the virologist's viewpoint].

Medical assistance to procreation in a couple with one of the parents having viral hepatitis raises the issue of the transmission of infection to the baby and of possible contaminations of gametes from virus-free parents in the laboratory. Today, the main problems are linked to hepatitis B and C viruses, which induce chronic disease transmissible to the baby and can be transmitted through laboratory contaminations.

Female↗

Sacred conceptions: clinical theodicies, uncertain science, and technologies of procreation in India.

This article argues that the rapid transfer of assisted conception technologies, such as in vitro fertilization, to India is not restricted merely to the modalities of offering potential biomedical resolution of infertility but includes, more crucially, how clinicians and infertile consumers assimilate the "Western technoscience" of conception. The article draws on a larger multisite ethnographic study of infertility and assisted conception in India's five major cities and is principally based on narratives of clinicians and infertile couples and on clinic-based ethnographic observations. In this article I contend that the success or failure of assisted conception, when situated in the universe of Hindu faith, becomes a powerful critique of the "incompleteness" of the "Western" science of conception. Situating this contention in the broader context of a clinician's faith, I assert that assisted conception--by conjoining seemingly disparate domains of the traditional and the modern, the sacred and the profane, the human and the superhuman, science and religion--produces clinical theodicies that help explain and contain the tentativeness permeating the conception technologies. The article concludes by arguing that this enchanted version of a thoroughly disenchanted worldview of biomedicine is part of a larger cultural process of indigenization of biomedicine in India.

Attitude to Health↗

Wrongful birth and the politics of reproduction: West German and English law considered.

This article considers the law relating to compensation in tort and contract for failed sterilizations and failed abortions leading to the birth of an unplanned but healthy child in the Federal Republic of Germany and England. It uses a policy-based analysis which takes the social construction of gender as a significant factor in judicial decision making. It criticizes existing literature for failing to take into account gender divisions in society and points to ways in which both the framework within which wrongful birth cases are discussed generally and the limitations which have been placed on recovery specifically reflect gender stereotyped notions of female and male behaviour and sexuality. I conclude that there are three main areas of concern in the wrongful birth cases: a) the inadequate recognition which the law accords to women's work in the home when awarding damages for maintenance of the unplanned child to majority; b) the awarding damages exercised by the politics of abortion, which can lead to undue restrictions on recovery; and c) the difficulties which the law experiences when attempting to conceptualize an interference in a woman's procreative autonomy in the same terms as an interference in a typically 'male' sphere of life, such as professional autonomy. Thus there is an urgent need to reconsider the categories of the law of obligations such as 'damage' and 'compensation', which are central to the principle of individual responsibility for harm caused, in order to reveal their gendered content and differential effects.

Abortion, Induced↗

Donor health assessment after living-donor liver transplantation.

OBJECTIVE: To elicit donor opinions on liver living donation through use of a survey that protected the anonymity of the respondent and to assay long-term (follow-up > 1 year) donor health by a widely recognized instrument for health assessment. SUMMARY BACKGROUND DATA: Living-donor liver transplantation is an accepted technique for children that has recently been extended to adults. Limited donor outcomes data suggest favorable results, but no outcomes data have been reported using an instrument that elicits an anonymous response from the donor or employs a widely recognized health survey. METHODS: Forty-one living-donors between June 1992 and June 1999 were identified and included in this study, regardless of specific donor or recipient outcome. Each donor received a 68-question survey and a standard McMaster Health Index. RESULTS: Survey response was 80%. All donors were satisfied with the information provided to them before donation. Eighty-eight percent of donors initially learned of living donation only after their child had been diagnosed with liver disease: 44% through the transplant center, 40% by popular media, 12% by their pediatrician, and 4% by their primary care physician. Physical symptoms, including pain and the surgical wound, were recurrent items of concern. Perception of time to "complete" recovery were less than 3 months (74%), 3 to 6 months (16%), and more than 6 months (10%). Donors' return to physical activities was shown by above-mean McMaster physical scores; scores for social and emotional health were not different from population data. There were no reported changes in sexual function or menstruation after donation, and five of six donors procreated. CONCLUSIONS: Donors overwhelmingly endorsed living donation regardless of recipient outcome or the occurrence of a complication. Eighty-nine percent advocated "increased" application of living donation beyond "emergency situations," and no donor responded that living donation should be abandoned or that he or she felt "forced" to donate.

Adult↗

Procreative liberty, embryos, and collaborative reproduction: a legal perspective.

This article discusses the implications of a constitutionally protected right to procreate using a wide range of reproductive choices made possible by noncoital reproductive technologies, including embryo freezing and donation and surrogate gestation. After establishing the constitutional basis for a positive right to procreate, it discusses the extent to which concerns about the welfare of embryos, offspring, donors, and surrogates justifies limitation on reproductive choice involving these technologies. While tangible harm to offspring and protection of the free choice of reproductive collaborators may justify regulation, moral condemnation of noncoital techniques and concerns about the reifying effects of their use are an insufficient basis for state restriction.

Child↗

Voluntary and involuntary sterilization: medical, ethical, legal and religious aspects.

Surgical voluntary sterilization has become one of the most widely used methods of contraception, with vasectomy and tubal sterilization being the most commonly employed techniques, associated with a low failure, morbidity, mortality, and long-term sequelae rate. As sterilization is related with the elimination of the possibility for procreation, a number of ethical, legal and religious issues have arisen, leading often to personal misjudgements, legal disputes, and failures in applying family planning. Involuntary sterilization is currently not practiced, except in cases of severely mentally retarded people, who are unable to appreciate the consequences of their acts or care for their children and who may have a high likelihood of propagating hereditary disease.

Ethics, Medical↗

The proposed model surrogate parenthood act: a legislative response to the challenges of reproductive technology.

In this Article, Manus proposes a Model Surrogate Parenthood Act. He examines the medical and scientific history of surrogacy and reviews the jurisprudence in the area, specifically the constitutional relationship between procreation rights and surrogacy. The author asserts that surrogate motherhood cannot be, and indeed, should not be, eradicated through legislation criminalizing it. The proposed Model Act, presented here in its entirety, attempts to reduce the problems inherent in the concept of surrogate parenthood by putting the process under strict court supervision and by zealously protecting the rights of the surrogate mother and the child to be conceived.

Female↗