A legal-ethical analysis of reproductive endocrinologists' right to refuse ovulation induction to patients with diminished ovarian reserve.

PURPOSE: Review of the legal and ethical basis for reproductive endocrinologists to refuse ovulation induction to patients with diminished ovarian reserve. METHODS: The Lexis-Nexis search engine was used to perform a legal review pertaining to refusal of treatment. Ethical opinions of medical organizations were also reviewed. RESULTS: Federal antidiscrimination laws provide legal recourse for patients with diminished ovarian reserve who are denied ovulation induction. However, the same laws also permit refusal of care when there is bona fide medical justification to decline services. In addition, the codes of ethics for relevant professional organizations support physicians' decisions to refuse treatment when treatment is futile. CONCLUSION: Although it is ethically and legally permissible to deny ovulation induction to patients with diminished ovarian reserve when medically justified, refusal may invite retaliatory litigation. Counseling remains a cornerstone in directing these patients to options with more potential for success, such as donor eggs and adoption.

Animal eggs for stem cell research: a path not worth taking.

In January 2008, the Human Fertilisation and Embryology Authority (HFEA) (London, UK) issued two 1-year licenses for cytoplasmic hybrid embryo research. This article situates the HFEA's decision in its wider scientific and political context in which, until quite recently, the debate about human embryonic stem cell research has focused narrowly on the moral status of the developing human embryo. Next, ethical arguments against crossing species boundaries with humans are canvassed. Finally, a new argument about the risks of harm to women egg providers resulting from research involving the creation of humanesque cytoplasmic hybrid embryos is elaborated. Taken together these ethical concerns about the moral status of the human embryo, about the ethics of crossing species boundaries with humans, and about the potential harms to women (concerns that independently are more or less weighty for different constituencies), provide good reason to eschew humanesque cytoplasmic hybrid embryo research in favor of less ethically controversial means to the laudable end of successful regenerative medicine.

Reluctance of medical professionals in adopting natural-cycle and minimal ovarian stimulation protocols in human clinical assisted reproduction.

Recent clinical evidence would suggest that natural cycle and minimal ovarian stimulation protocols in clinical assisted reproduction could be advantageous for younger women with indications for either male-partner or mild female-factor subfertility. The benefits include reduced medical fees associated with lower or nil dosages of recombinant gonadotrophins, a shorter treatment cycle and reduced risk of ovarian hyperstimulation syndrome. Additionally, there is also evidence to suggest improved quality of retrieved oocytes and better endometrial receptivity. Nevertheless, fertility clinics and doctors have conflicting interests that make them reluctant to incorporate natural-cycle and minimal stimulation protocols in their treatment programme. Firstly, the use of low or nil dosages of recombinant gonadotrophins would drastically cut profits from drug prescription sales to patients. Secondly, fertility clinics are also concerned by the apparent reduction in success rates for natural-cycle and minimal ovarian stimulation protocols. Moreover, refunding of medical bills by health insurance is usually based on a limited number of attempts, thereby hampering the introduction of natural-cycle and minimal stimulation protocols, which have lower efficacy on a per cycle basis. Lastly, the adoption of natural-cycle and minimal stimulation protocols would drastically reduce the numbers of surplus oocytes and embryos available for donation to other patients.

The student and the ovum: the lack of autonomy and informed consent in trading genes for tuition.

Rising tuition costs have forced university students to become creative in finding ways to fund their education. Some female university students have decided that ova donation may be an acceptable alternative in which to pay for their tuition. This alternative presents itself because of the insufficient number of ova available for assisted reproduction and emerging stem cell technologies. Young female university students are encouraged by Internet sources and respectable electronic and print media to donate their ova in the cause of assisted reproduction for monetary compensation. While university students generally exhibit autonomy, the constraining influence of their financial predicament compromises the elements of informed consent (voluntariness, competence, capacity, understanding, and disclosure) as to their making an autonomous decision in regard to egg donation. Thus, any moral possibility of giving informed consent is negated. Informed consent can only occur through autonomy. A female university student in need of financial resources to pay for her education cannot make an autonomous choice to trade her genes for tuition. Donated ova are not only needed for assisted reproduction, but for stem cell technologies. While the long-term health of women who donate their ova is of concern (a potential risk of cancer after long term use of ovulation induction), of equal concern is the possibility of a growth in the trade of ova targeting third world and Eastern European women where the precedence for autonomy and informed consent is not well established.

[Stem cells and therapeutic cloning, medical perspectives under discussion]. / Cellules souches et clonage thérapeutique, des perspectives médicales en débat.

Innovative biotechnical progress over the past few years regards stem cells and therapeutic cloning, which open promising medical horizons for many presently incurable diseases. THE CURRENT DEBATE: The research work in France has been stalled because of the prohibitions listed in the so-called "bioethical" laws of 1994. The ongoing revision of these laws is based on a certain number of ethical questions and launches a disputable parlementary debate. Other than reproductive cloning and research on the embryo, the possibilities provided by stem cells and therapeutic cloning should be emphasized and the different positions advanced specified, showing an evolution in the laws in France. ABUSIVE LEGISLATIVE PROHIBITIONS: The proposed law, which maintains the prohibition for research on the embryo, with a 5-Year dispensation, and which explicitly prohibits therapeutic cloning, is not in keeping with the widening of in this field expected by research teams. Many scientists and physicians, supported by patients' associations, are aware of the importance of therapeutic progress attached to such research. They should not be stalled in their studies by the prohibitions maintained in the new law.