Based on the "Guide to the Human Fertilisation and Embryology Act 1990", this volume reviews the regulation of assisted conception including complex moral issues such as abortion, embryo research and cloning.

The debate about the moral status of the embryo has gained new impetus because of the advances in reproductive technology that have made early human embryo experimentation a possibility, and because of the public concern that this arouses. Several philosophical arguments claiming that fertilisation is the event that accords moral status to the embryo were initially formulated in the context of the abortion debate. Were they formulated with sufficient precision to account for the scientific facts as we now understand (...) them? Or do these arguments need modification? Aspects of three arguments for moral status being acquired at fertilisation are examined in relation to current scientific knowledge, highlighting the reasons why such arguments, at present, seem to provide an inadequate basis for the determination of moral status. (shrink)

The Human Fertilisation and Embryology Act 2008: a missed opportunity?Amel AlghraniCorrespondence to Dr Amel Alghrani, Institute for Science, Ethics and Innovation, Centre for Social Ethics and Policy, School of Law, University of Manchester, Oxford Road, Manchester, M13 9PL; [email protected] 16 September 2009 Accepted 24 September 2009 Regulating reproduction is no easy feat. In the past three decades we have witnessed a reproductive revolution and great strides have been made to alleviate the effects of infertility. Reproductive advances such as in-vitro (...) fertilisation , sex selection, reproductive cloning and embryo selection for the purpose of creating “saviour siblings” have all emerged as part of a rapid and ever-changing branch of medicine, each promising to upset the status quo and transform human reproduction.Following much activity in this area, the lengthy process of updating the legislation is now complete. The Human Fertilisation and Embryology Act 2008 received Royal Assent on 13 November 2008. The majority of the HFE Act 2008’s amendments will come into force in October of this year, with the exception of the provisions pertaining to parenthood, which commenced in April 2009. Welcoming Royal Assent, Professor Lisa Jardine, Chair of the Human Fertilisation and Embryology Authority, stated:“This is a momentous day for the HFEA and for those with fertility problems. The regulatory system that has served us so well has been renewed. Parliament has provided a clear framework for the future and a solid base on which to regulate 21st century practice within 21st century law.”1However, as scientific endeavours into developments such as artificial gametes, womb transplantation and ectogenesis continue apace, it could be argued that Jardine was perhaps overly optimistic about the achievements of the new legislation. The HFE Act 2008 is an amending statute, and as Jackson 2 notes “much of the regulatory architecture” in the 1990 legislation “remains intact”. In retaining the architecture of the 1990 legislation, and merely amending or adding certain provisions, has the government missed an ideal opportunity to consider how to equip the regulatory framework for the next phase/era of assisted reproduction?The next …. (shrink)

In vitro fertilisation is now an established technique for treating some forms of infertility, yet it remains ethically controversial. New developments, such as embryo donation and embryo freezing, have led to further discussion. We briefly discuss the ethical aspects of IVF, focusing on the issues of resource allocation, the 'unnaturalness' of the procedure, the moral status of the embryo, surrogate motherhood, and restrictions on access to IVF. We argue that, on the whole, IVF is an ethically justifiable method of (...) assisting infertile couples. (shrink)

ABSTRACT This article deals with a cluster of moral problems raised by the new techniques of human fertilisation. It is concerned primarily with the putative rights of embryos brought into being as a by‐product of the practice of in vitro fertilisation. In this connection it investigates the basis for the ascription of rights to entities and asserts the view that consciousness is a pre‐requisite for the possession of rights. It draws attention to the speciesism implicit in attitudes of (...) some of those who have contributed to the debate. It also examines other issues briefly, raising, for example, the question whether children by AID (or by in vitro fertilisation by donor) must be denied access to information about their genetic fathers; and looking at objections to the new techniques based on the so‐called unnaturalness of the procedures involved. (shrink)

Technological advances in genetic testing have enabled prospective parents to learn about their risk of passing a genetic condition to their future children. One option for those who want to ensure that their biological children do not inherit a genetic condition is to create embryos through in vitro fertilisation and use a technique called preimplantation genetic testing to screen embryos for genetic abnormalities before implantation. Unfortunately, due to its high cost, IVF-with-PGT is out of reach for the vast majority (...) of Americans. This article addresses an issue that has been underexplored in the medical ethics literature: the lack of insurance coverage for IVF-with-PGT.Within the US system, a key concept in insurance is that of medically necessary care, which broadly consists of diagnostic services and treatment services. In this article, I argue that IVF-with-PGT could be classified as either a diagnostic service or as a treatment service. To make this case, I show that IVF-with-PGT is similar to other types of services that are often covered by US insurance providers. In light of these similarities, I argue that the current system is inconsistent with respect to what is—and is not—covered by insurance. To promote consistency and fairness in coverage, like cases should be treated alike—starting with greater coverage for IVF-with-PGT. (shrink)

This article briefly reviews the various papers contained in this volume. They were originally presented at a research workshop held at Keele University in the UK in February 2003. It is suggested that the different papers raise a series of related legal, social and ethical issues and can be collectively seen to demonstrate the fact that policy formation in relation to reproductive matters is highly contested. It is concluded that ethical policy formation in this area needs to be based on (...) actual evidence of harm rather than assumed harm and that this therefore entails more empirical research into reproductive matters. (shrink)

Of all the changes to the Human Fertilisation and Embryology Act 1990 that were introduced in 2008 by legislation of the same name, foremost to excite media attention and popular controversy was the amendment of the so-called welfare clause. This clause forms part of the licensing conditions which must be met by any clinic before offering those treatment services covered by the legislation. The 2008 Act deleted the statutory requirement that clinicians consider the need for a father of any (...) potential child before offering a woman treatment, substituting for it a requirement that clinicians must henceforth consider the child’s need for “supportive parenting”. In this paper, we first briefly recall the history of the introduction of s 13(5) in the 1990 Act, before going on to track discussion of its amendment through the lengthy reform process that preceded the introduction of the 2008 Act. We then discuss the meaning of the phrase “supportive parenting” with reference to guidance regarding its interpretation offered by the Human Fertilisation and Embryology Authority. While the changes to s 13(5) have been represented as suggesting a major change in the law, we suggest that the reworded section does not represent a significant break from the previous law as it had been interpreted in practice. This raises the question of why it was that an amendment that is likely to make very little difference to clinical practice tended to excite such attention (and with such polarising force). To this end, we locate debates regarding s 13(5) within a broader context of popular anxieties regarding the use of reproductive technologies and, specifically, what they mean for the position of men within the family. (shrink)

This note suggests that, viewed from a feminist perspective, the reforms contained in the Human Fertilisation and Embryology Act 2008 represent a missed opportunity to re-think the appropriate model of regulation to govern fertility treatment and embryology research in the UK. It argues that reform of the legislation was driven largely by the government’s desire to avoid re-igniting controversies over the legal status of the embryo and abortion and to maintain Britain’s position at the forefront of embryo research and (...) related biotechnologies. It also highlights the importance of media debates, which were highly selective, to the reform process, and suggests that in order to inject feminist values into the process of legislative reform, feminists need to become more media savvy. In the short term, it suggests that there is little prospect of a radical re-thinking of the appropriate ethico-legal response to the wide variety of family forms that reproductive technologies potentially enable, much less of considering our ethical obligations to the new forms of embryos that are now permitted by the 2008 Act. In the meantime, however, it argues that these issues provide productive opportunities for feminist legal theorists to address questions that have been erased or obscured in the course of the 2008 reforms. (shrink)

Nous chercherons ici à montrer comment le projet Tela Botanica permet à la fois une transformation et une actualisation du savoir botanique. Trois éléments particuliers retiendront notre attention : la libre circulation et la mise à disposition des données les plus récentes du travail des botanistes ; l’articulation nouvelle entre le travail scientifique des amateurs et celui des professionnels ; la création d’une forme organisationnelle hybride combinant des éléments propres au milieu associatif et à l’entreprise privée. Nous utiliserons ces trois (...) axes d’analyse tour à tour, en fournissant des exemples et des réflexions théoriques pour chacun.This article illustrates how the Tela Botanica project is simultaneously transforming botanical knowledge and breathing new life into the field of botany. We discuss three characteristics in particular: the ready availability and free circulation of the most up-to-date botanical data, new links between the scientific work of amateur and professional botanists and the appearance of a hybrid organisational form that combines features from the non-profit model and from private enterprise. We examine these three characteristics in turn, with examples and theoretical discussions in each case. (shrink)

Madison Kilbride recently argued that insurance ) should cover in vitro fertilisation with preimplantation genetic testing services for couples at high risk of having a child affected with a genetic condition. She argues that IVF-PGT meets CMS’s definition of ‘medically necessary care’, where such care includes ‘services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms’. Kilbride argues that IVF-PGT satisfies this definition in two ways: as a diagnostic tool and as a treatment. (...) Contradicting Kilbride, however, I argue that IVF-PGT provides neither diagnosis nor treatment under CMS’s definition. Thus, as long as we accept CMS’s definition of medically necessary care—which Kilbride does, explicitly—it follows that IVF-PGT does not count as medically necessary care. Still, there may be other reasons to conclude that IVF-Preimplantation genetic testing should be covered, and so, it would be a mistake to reject Kilbride’s conclusion altogether. The problem is simply that Kilbride’s argument—that the procedure should be covered because it is medically necessary per CMS’s definition—is not sound. I conclude by discussing a number of other genetic services that are not currently being covered despite the fact that they do seem to satisfy CMS’s definition of ‘medically necessary diagnosis or treatment’. These services, I argue, should be provided under CMS before we consider expanding coverage to include elective procedures such as IVF-PGT. (shrink)

Background: Today in vitro fertilisation is a widespread and important technique of reproductive medicine. When the technique was first used, it was considered ethically controversial. This is the first study conducted of adult IVF-offspring in order to learn about their ethical opinions and personal attitudes towards this medical technology.Methods: We recruited the participants from the first cases of in vitro fertilisation in Germany at the Gynaecological Clinic of the University Hospital Erlangen. Our qualitative interview study consisted of in-depth, (...) face-to-face interviews with 16 adults who had been conceived by IVF. Our data was analysed with methods of Grounded Theory.Results: For these adults, the most important factor influencing their personal attitudes towards IVF was the knowledge that they were deeply wanted children. The artificiality of their conception seemed irrelevant for their ethical opinion. All participants mentioned that it was important for them to be informed about the circumstances of their conception by their parents.Conclusions: IVF seems to be a medical technique which, although it affects intimate aspects of human existence, can be integrated into the lives of the affected persons without any great difficulties. The findings suggest that parents should inform their children about their fertilisation at an early age and as part of a process over time, not only on a single occasion. Physicians should advise IVF-parents accordingly. (shrink)

There exists a derived negative right to procreative freedom, including a right to in vitro fertilisation (IVF) and to the exercise of selective techniques such as preimplantation genetic diagnosis. This is an extensive freedom, including not only the right to the exercise of a responsible parenthood, but also, in rare cases, to wrong decisions. It includes also a right for less than perfect parents to the use of IVF, and for IVF doctors to assist them, if they want and (...) can agree about the terms. (shrink)

The Department of Health's Review of the Human Fertilisation and Embryology Act 1990 is a comprehensive public consultation on the regulation of the storage and use of gametes and embryos for fertility treatment and research in the UK. The consultation considers a range of issues, including the model and scope of regulation and proposals for a single body, the Regulatory Authority for Tissue and Embryos, to replace both the Human Fertilisation and Embryology Authority and the Human Tissue Authority (...) by April 2008. The Department of Health published its report on the consultation in March 2006, and this is discussed here in relation to both the support and criticisms of the model and scope of the current and proposed regulatory frameworks, particularly with regard to policy decision-making by bodies such as HFEA and RATE. (shrink)

ZusammenfassungEines der medizinischen Felder, in dem die ethische Diskussion um die „wunscherfüllende Medizin“ am intensivsten geführt wird, ist die Reproduktionsmedizin, die die Erfüllung des „Kinderwunsches“ verspricht. Strittig ist besonders, ob Sterilität als Krankheit definiert wird, die eine medizinische Intervention rechtfertigt, ob sich aus der Sterilität oder Infertilität lediglich ein Abwehr- oder auch ein positives Anspruchsrecht auf medizinische Ressourcen ergibt, ob legitime Fortpflanzungsmedizin Grenzen hat. Nach einer Übersicht über Eckpunkte der nationalen und internationalen Debatte beschreiben wir im zweiten Teil Ansichten zum (...) Status ungewollter Kinderlosigkeit, zum Recht auf Fortpflanzungsmedizin und zur möglichen Legitimität ihrer Begrenzung anhand der Ergebnisse unserer vom Bundesministerium für Bildung und Forschung (BMBF) geförderten Studien. Während der letzten fünf Jahre haben wir u. a. Paare mit und ohne Sterilitätsproblematik sowie verschiedene Expertengruppen qualitativ und standardisiert befragt. Die stark divergierenden Auffassungen konfrontieren wir im dritten Abschnitt mit internationalen Standards, zum anderen mit dem „Capability-Ansatz“ und dem freiheitsfunktionalen Liberalismus von Sen und Pauer-Studer. Dies ergibt, dass die Bereitstellung verschiedener Möglichkeiten der In-vitro-Fertilisations-(IVF-)Behandlung nicht lediglich einen Wunsch auf Elternschaft erfüllt sondern als die gesollte Erfüllung eines normativen Bedürfnissanspruchs begriffen werden muss. (shrink)

Bilingual Discourse and Cross-Cultural Fertilisation: Sanskrit and Tamil in Medieval India. Edited by Whitney Cox and Vincenzo Vergiani with an introduction by Dominic Goodall. Collection Indologie, vol. 121. Pondicherry: Institut Français de Pondichéry / École Française d’Extrême-Orient, 2013. Pp. x + 466. Rs. 900, €38.

ZusammenfassungEines der medizinischen Felder, in dem die ethische Diskussion um die „wunscherfüllende Medizin“ am intensivsten geführt wird, ist die Reproduktionsmedizin, die die Erfüllung des „Kinderwunsches“ verspricht. Strittig ist besonders, ob Sterilität als Krankheit definiert wird, die eine medizinische Intervention rechtfertigt, ob sich aus der Sterilität oder Infertilität lediglich ein Abwehr- oder auch ein positives Anspruchsrecht auf medizinische Ressourcen ergibt, ob legitime Fortpflanzungsmedizin Grenzen hat. Nach einer Übersicht über Eckpunkte der nationalen und internationalen Debatte beschreiben wir im zweiten Teil Ansichten zum (...) Status ungewollter Kinderlosigkeit, zum Recht auf Fortpflanzungsmedizin und zur möglichen Legitimität ihrer Begrenzung anhand der Ergebnisse unserer vom Bundesministerium für Bildung und Forschung (BMBF) geförderten Studien. Während der letzten fünf Jahre haben wir u. a. Paare mit und ohne Sterilitätsproblematik sowie verschiedene Expertengruppen qualitativ und standardisiert befragt. Die stark divergierenden Auffassungen konfrontieren wir im dritten Abschnitt mit internationalen Standards, zum anderen mit dem „Capability-Ansatz“ und dem freiheitsfunktionalen Liberalismus von Sen und Pauer-Studer. Dies ergibt, dass die Bereitstellung verschiedener Möglichkeiten der In-vitro-Fertilisations-(IVF-)Behandlung nicht lediglich einen Wunsch auf Elternschaft erfüllt sondern als die gesollte Erfüllung eines normativen Bedürfnissanspruchs begriffen werden muss. (shrink)

Changes in breeding system are a regular evolutionary change in plants, as self‐fertilisation is often advantageous, particularly for weedy and colonising species. The adoption of Arabidopsis thaliana as a plant model species has led to interest in how self‐incompatibility was lost so that this species became highly inbreeding. Molecular evolutionary approaches have recently focused on investigating two loci involved in the incompatibility recognition process in related Arabidopsis species; non‐functional copies of these genes still exist in A. thaliana. New work (...) studying polymorphism at these loci found strikingly low diversity at one of them, suggesting that spread of a mutation in this gene might have caused self‐compatibility in an ancestor of A. thaliana.1 However, it is difficult to be sure of the time when the selfing habit evolved in the lineage that led to A. thaliana BioEssays 27:472–476, 2005. © 2005 Wiley Periodicals, Inc. (shrink)

In vitro fertilisation (IVF) daily practice reveals that couples are willing to take greater risks than doctors if there is a higher chance of pregnancy. Arising from this is a frequently addressed issue regarding the embryo transfer strategy: single or double embryo transfer? The dilemma is faced by patients, as well as physicians, who are caught between the possibility of no pregnancies at all and facing the prospect of iatrogenic twin gestation. How could the couple's preferences concerning how many (...) children they would like be taken into account in determining the number of embryos transferred? How should the physician exercise his medical responsibility towards his patients and the unborn child? An effective approach could be to enhance a couple’s autonomy by advocating a medical beneficence that incorporates patients’ values. This can be achieved through a case-by-case approach in a deliberative process of decision-making which includes real patient-centred communication. (shrink)

In an article in an earlier edition of the Journal of Medical Ethics (1) Dr Iglesias bases her analysis upon the mediaeval interpretation of Platonic metaphysics and Aristotelian logic as given by Aquinas. Propositional forms are applied to the analysis of experience. This results in a very abstract analysis. The essential connection of events and their changing temporal relationships are ignored. The dichotomy between body and soul is a central concept. The unchanging elements in experience are assumed to be more (...) real than the actual world of experienced process. Such a view makes the analysis of the temporal factors in experience impossible. Its abstractness is quite unsuitable for the analysis of the ontological structure and development of the neonate from fertilisation to birth. A N Whitehead made the notion of organism central to his philosophy. He refused to place human experience outside nature, or admit dualism. His philosophy of organism is an attempt to uncover the essential elements connecting human experience with the physical and biological sciences. Time, change and process are, in his view, more real than the static abstractions obtainable by the use of the fallacy of misplaced concreteness. Use of the latter negates the essential connectedness of events and the importance of temporarily and change (2). In this paper I argue that the embryo, being an organism, is not analysable in terms of thinghood. It is a process. To apply Aristotelian logical concepts to it is to distort the real nature of the datum. (shrink)