New reproductive technologies: some legal dilemmas.
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The foregoing discussion was intended as a review of the pertinent literature of involuntary sterilization. It is by no means all-inclusive (the number of cases precludes an exhaustive compendium) but does include those cases that, in the authors' opinion, are most representative of the contemporary attitude of the courts. The discussion has been confined primarily to the legal aspects of involuntary sterilization. We have omitted any substantial discussion of the moral and ethical aspects of this complex topic but acknowledge the intimate role these issues may play in any decision to undertake involuntary sterilization. As outlined, the presence or absence of statutory guidelines mandates in part the legal channels to be pursued. In the presence of statutes for involuntary sterilization, strict adherence to the specified requirements provides the optimal means of protecting the legal interests of all involved parties. In the absence of statutory guidelines, extreme caution must be exercised. In these circumstances, a validly executed court order observing procedural due process should provide optimal protection of patient and physician interests. The decisions of New Jersey and Alaska courts represent one potential method of securing a consent by use of the parens patriae doctrine. Recent notable efforts at a state level to dispense with lengthy hearings and implement committee review have been encouraging and await further trials to determine their ultimate role in authorizing sterilization of mental incompetents. Given the current legal climate and available avenues, parental substituted consent without adequate hearing and due process should not be considered a fulfillment of legal responsibilities.
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Even leaving aside the question of the impact of reproductive technology on property law, successions, commercial law and the legal qualification to be given to some of the relationships it entails (e.g. 'deposit' of genetic material, 'lease and hire' of wombs, 'gifts' of embryos), there is no doubt that, like the discovery of the atom, no other scientific advance portends such an enormous potential for human benefits or harm. No other scientific advance will so affect the personal, intimate life of the individual person in its public or private aspects. Beginning then with the positive law (Part I), we will attempt to trace, albeit summarily, possible legal approaches to reproductive technology in Canada and to conclude with an overview of proposed reforms (Part II).
The development of medical means of inducing abortion requires a detailed knowledge of the abortion legislation. It is vital that these compounds are developed and used within the legal constraints of the country involved. In the United Kingdom, despite the Act of Union (1707), England and Scotland have not united under one legal system. In England the common law on abortion was superseded by the Offences Against the Persons Act (1861) which declared abortion illegal. This Act does not apply to Scotland where, up until 1967, common law applied. The Abortion Act of 1967 is an exemption act allowing abortion, under certain restrictions, to be legally performed. Whilst post-coital contraception is not covered by any of the abortion legislation, it is clear that contragestion and medical abortion is restricted by the current abortion legislation, hence medication will need to be taken in hospital.
A fetus may survive an intentional interference with its intrauterine environment (1) if gestational age is mistaken and the procedure of induced abortion does not kill the fetus, (2) if a change of heart takes place after abortifacient drugs are taken and the abortion does not proceed, and (3) if a high-multiple pregnancy is reduced to a singleton or a twin pregnancy to improve the likelihood that the remaining fetuses will reach viability. In each case, through cause or coincidence, an abnormal baby may be born. The well-intentioned physician, responding to a patient's medical or psychological needs, risks a legal action in negligence or assault brought by a deformed surviving child. This hazard means that medical termination of pregnancy and selective pregnancy reduction put the practising physician at substantial risk in a way not usually associated with induced abortion.
In the early 1980s, the leadership of the antiabortion movement became involved in a campaign to establish legal rights to extraordinary medical care for seriously handicapped newborns. Armed with political contacts in the Reagan administration and Congress, and allied with advocates for the disabled, the antiabortion movement searched for a test case to guide through the courts. Antiabortion advocate Lawrence Washburn found such a case in Baby Jane Doe, who was being treated at Stony Brook Medical Center. The movement went on to amend the Child Abuse Act to include protections for handicapped newborns. Activists in the movement chose the issue of Baby Jane Doe because they believed it would attract welcome publicity, give them the appearance of supporting civil rights, and enhance their argument as to the legal rights of the fetus and thus strengthen the case against abortion. The movement was partially successful in obtaining its goals.
Consent by patients to voluntary sterilization frees surgeons from criminal responsibility for assault when such consent is given freely with the knowledge of the purpose and consequence of the procedure, and when the operation is performed with professional skill. However, it is considered unethical for surgeons to sterilize a married man or woman of child-bearing age unless they have satisfied themselves that the other party to the marriage has consented to the procedure.
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This article presents a critical analysis of the contractual status and implications of surrogate motherhood agreements in the Netherlands. Particular attention is focussed on the notions of freedom of contract and the public interest as two distinctive but interrelated determinants in assessing the legal consequences of avoidance of the terms of surrogate motherhood agreements by the prospective surrogate mother and/or the prospective parents.
The federally funded Human Genome Initiative will lead to the development of new capabilities to learn about an individual's genetic status. Legal issues are raised concerning patients' and other parties' access to that information. This article discusses the effect of existing statutes and case law on three pivotal questions: To what sort of information are people entitled? What control should people have over their genetic information? Do people have a right to refuse genetic information? The article emphasizes that the law protects a patient's right to obtain or refuse genetic information about oneself, as well as the right to control the dissemination of that information to others.
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Women who wish to terminate a pregnancy, and physicians willing to perform abortions, are subject to increasing harassment from groups which challenge the constitutional abortion right upheld by the Supreme Court in Roe v. Wade. Their vulnerability, in fact, parallels the vulnerability of the abortion right. This Article analyzes the inherent weakness and impending obsolescence of the trimester framework established in Roe. Present medical evidence of maternal health risks and fetal viability demonstrates that the trimester framework is inconsistent with current medical knowledge, and will likely be rendered obsolete by developments in medical technology. The Article suggests that adoption of an alternative constitutional basis for legal abortion is necessary to preserve the abortion right, and explores the utility of two arguments grounded in the equal protection doctrine. Finally, it discusses means of preserving legal abortion within the confines of the trimester framework established in Roe v. Wade.
All areas of medical practice are shaped by ethical and legal mandates. When a physician provides infertility services, however, ethical and legal concerns reach an even greater prominence. The infertility specialist is in the awesome role of facilitating the creation of new life. A task of that level of importance brings with it responsibilities of an equal magnitude. Clinicians performing in-vitro fertilization and artificial insemination should be especially sensitive to the ethical and legal concerns raised by the selection of patients and donors, the informed consent process, and record-keeping. As reproductive technologies such as these develop, the clinician not only has a duty to monitor their safety and efficacy, but also to provide extensive information to the participants and to society at large to make possible informed decisions about how best to enhance the benefits and avoid the risks of these new technologies.