Effect of Opt-out System for Organ Donation After Brain Death on Ethical Legitimacy and Potential Efficacy in a Mathematical Model.

OBJECTIVES: We aimed to compare the possible outcomes of the current (opt-in) system and an opt-out system for organ donation in South Korea using a mathematical model. MATERIALS AND METHODS: A structured questionnaire was used to investigate the decision on organ donation and family consent after brain death under the current system and an opt-out system. The survey was conducted in August 2018 by means of a voluntary survey of 100 opposite-sex married couples. RESULTS: Sixty-three percent of participants wished to self-donate their organs after brain death: 69.5% were positive and 30.5% were negative regarding the implementation of the opt-out system. Among 200 participants, the total number of possible donors increased from 110 (55.0%) in the current system to 139 (69.5%) in the opt-out system. Positive autonomy was defined as obtainment of consent from the donor and the spouse, and negative autonomy was defined as concordaence of refusal between the donor and the spouse. Comparisons between the systems showed that the rate of autonomy increased from 57.0% in the current system to 61.5% in the opt-out system. Although the achievement of positive autonomy increased from 59.5% in the current system to 74.6% in the opt-out system, the achievement of negative autonomy decreased from 52.7% in the current system to 39.2% in the opt-out system. CONCLUSIONS: An opt-out system can increase the number of organ donors; however, achievement of negative autonomy can decrease.

It Takes a Village to Raise a Child: Solidarity in the Courts-Judicial Justification for Posthumous Use of Sperm by Bereaved Parents.

The practice of posthumous use of sperm raises social, ethical, and legal questions. We examine the issue of who should be allowed to use the sperm-only the deceased's spouse or the deceased's parents as well-from the perspective of solidarity and relational autonomy. Following a theoretical discussion of various accounts of solidarity and relational autonomy, the legal status of posthumous assisted reproduction is examined in three jurisdictions-the USA, Australia, and Israel-in which most applications to the courts were submitted by the deceased's parents. In Israel, we found fifteen court rulings on requests for posthumous use of sperm and fourteen in Australia. A smaller number were found in the case of the USA. The analysis reveals that Israeli and Australian courts employ solidarity-based arguments to justify their decisions to allow posthumous use of sperm, particularly when the deceased's true wishes are unknown. We thus conclude that the posthumous use of sperm can be legally extended to include the deceased's parents based on solidarity and relational autonomy arguments.

The Discriminatory Legal Barrier of Partner Consent in Victorian ART Law: EHT18 v Melbourne IVF.

In September 2018, the Federal Court of Australia found that a Victorian woman did not need her estranged husband's consent to undergo in vitro fertilisation treatment (IVF) using donor sperm. The woman, who was 45 years of age, made an urgent application to the Court for permission to undergo IVF using donor sperm. In a single judge ruling, Griffiths J held that the requirement in the Assisted Reproductive Treatment Act 2008 (Vic) ('ART Act') for a married woman to obtain the consent of her husband discriminated against the woman in question on the basis of her marital status in contravention of the Commonwealth Sex Discrimination Act 1984 (Cth) ('SD Act'). His Honour declared the Victorian law in this instance 'invalid and inoperable' by operation of section 109 of the Commonwealth Constitution to the extent it was inconsistent with the Commonwealth law. Although the declarations by the Federal Court were limited in their terms to the circumstances of the case, the judgment raises broader issues about equity of access to assisted reproductive treatment (ART) in Victoria. The issue of partner consent as a barrier to access to ART was specifically raised by an independent review of the ART Act in Victoria. The Victorian Government released an interim report late last year as a first stage of the review, which canvasses some options for reform. This raises a broader question as to whether prescriptive legislation imposing detailed access requirements for ART is necessary or even helpful.

Lesbian Pregnancy: Care and Considerations.

The constructs and the provision of preconception and obstetrical care have historically been based on the assumption of heterosexuality, and have often excluded lesbian women. However, due to significant strides in lesbian, gay, bisexual, transgender, and queer (LGBTQ) civil rights, more lesbian women desire to create and expand their families, and lesbian parented families are increasing. This places obstetrical care providers at the forefront of the movement to build inclusive health care environments. Therefore, it is incumbent upon those of us who work in obstetrics to understand, recognize, and respect the unique cultural considerations that pertain to lesbian women and couples seeking parenthood. This review seeks to provide culturally sensitive guidance on the specific concerns and challenges lesbians face, from preconception care to postpartum care, and briefly addresses legal issues and considerations for the nonbiologic mother. The recommendations outlined here are drawn from studies of the experiences of lesbian women with pregnancy. However, the scientific literature is very limited, and there is a clear need for additional obstetrical research focused on this patient group. As professionals committed to assuring optimal outcomes for all obstetrical patients, it is crucial that we promote the inclusion of sexual minority women in our clinical practices and research endeavors.

Fertility Counseling and Treatment for Certain Veterans and Spouses. Interim final rule.

The Department of Veterans Affairs (VA) amends its regulation regarding fertility counseling and treatment available to certain veterans and spouses. VA currently provides certain infertility services other than in vitro fertilization (IVF) to veterans as part of the medical benefits package. IVF is the process of fertilization by manually fertilizing an egg, and then transferring the embryo to the uterus. This interim final rulemaking adds a new section authorizing IVF for a veteran with a service-connected disability that results in the inability of the veteran to procreate without the use of fertility treatment. In addition, we add a new section stating that VA may provide fertility counseling and treatment using assisted reproductive technologies (ART), including IVF, to a spouse of a veteran with a service-connected disability that results in the inability of the veteran to procreate without the use of fertility treatment. VA will provide ART treatment, including IVF, to these veterans and spouses as specified in the Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2017, and Zika Response and Preparedness Act to the extent such services are consistent with the services available to enrolled veterans under the medical benefits package.

Changes in Reported Sexual Orientation Following US States Recognition of Same-Sex Couples.

OBJECTIVES: To compare changes in self-reported sexual orientation of women living in states with any recognition of same-sex relationships (e.g., hospital visitation, domestic partnerships) with those of women living in states without such recognition. METHODS: We calculated the likelihood of women in the Nurses' Health Study II (n = 69 790) changing their reported sexual orientation between 1995 and 2009. RESULTS: We used data from the Nurses' Health Study II and found that living in a state with same-sex relationship recognition was associated with changing one's reported sexual orientation, particularly from heterosexual to sexual minority. Individuals who reported being heterosexual in 1995 were 30% more likely to report a minority orientation (i.e., bisexual or lesbian) in 2009 (risk ratio = 1.30; 95% confidence interval = 1.05, 1.61) if they lived in a state with any recognition of same-sex relationships compared with those who lived in a state without such recognition. CONCLUSIONS: Policies recognizing same-sex relationships may encourage women to report a sexual minority orientation. Future research is needed to clarify how other social and legal policies may affect sexual orientation self-reports.

Family and Medical Leave Act; Definition of Spouse. Final rule.

The U.S. Office of Personnel Management (OPM) is revising the definition of spouse in its regulations on the Family and Medical Leave Act (FMLA) as a result of the decision by the United States Supreme Court holding section 3 of the Defense of Marriage Act (DOMA) unconstitutional. The new definition replaces the existing definition, which contains language from DOMA that refers to "a legal union between one man and one woman.'' The new definition permits Federal employees with same-sex spouses to use FMLA leave in the same manner as Federal employees with opposite-sex spouses.

Definition of spouse under the Family and Medical Leave Act. Final rule.

The Department of Labor's (Department) Wage and Hour Division (WHD) revises the regulation defining "spouse" under the Family and Medical Leave Act of 1993 (FMLA or the Act) in light of the United States Supreme Court's decision in United States v. Windsor, which found section 3 of the Defense of Marriage Act (DOMA) to be unconstitutional.

Substitute consent in women with psychosis.

When treating patients with schizophrenia, substitute consent for treatment is often needed because of the patient's decisional incapacity. The goal of this article is to illustrate the potential problems involved in surrogate decision-making in a mental health service for women. A composite case vignette that highlights these issues is presented. The vignette was developed based on files from a women's clinic for psychosis and a selective literature review. The quality of the relationship between marriage partners and the possibility of pregnancy, motherhood, and child custody disputes all complicate the ethics of next- of-kin surrogate decision-making. The concept of "best interests" (the mother's or the child's) is not straightforward. A related ethical issue is whether/when to disclose psychiatric information to spouses. It is hoped that this paper will engender further discussion in medicine, cultural studies, ethics, and the law.

Tuberculosis among newly arrived foreign spouses before obtaining citizenship, Taiwan, 2006-2011.

BACKGROUND: Taiwan's criterion for admissions of new immigrants is a normal chest X-ray (CXR). Subsequent tuberculosis (TB) screening for new foreign spouses is mandatory before acquiring citizenship. OBJECTIVES: To estimate the TB burden among new-entry foreign spouses and their close contacts. RESULTS: Of 768 new foreign spouses with TB, of whom 98.6% were female, 721 (94.0%) had come from South-East Asian countries (Viet Nam, Indonesia, Philippines and Thailand) or China. Rates of TB (40.3-176.2 per 100 000/year) among newly emigrant wives aged 20-49 years were 1.7- to 7.3-fold higher than among Taiwanese females of corresponding ages. TB prevalence among the 2698 close contacts of 768 foreign spouse index cases was 1.2%, according to a 2-year follow-up investigation. Respectively 87.9% (675/768) and 11.1% (85/768) of all TB cases had abnormal and normal CXRs; of these, 35.4% (239/675) of patients with an abnormal and 14.1% (12/85) of those with a normal CXR were smear-negative, culture-positive. CONCLUSIONS: Foreign wives from endemic countries had a relatively high risk of TB. Regular TB screening of foreign spouses within at least 1-2 years of entry from TB-endemic regions, rather than after application for citizenship, is recommended. A more sensitive TB test could facilitate better diagnosis.

[Evaluating the total incapacity to work: implementing French National Authority for Health guidelines in clinical practice]. / Détermination de l'incapacité totale de travail au sens du Code pénal: mise en œuvre des recommandations de la Haute Autorité de santé en pratique clinique.

Total incapacity to work (TIW) is a legal concept that allows magistrates to assess the severity of violence against persons. The TIW is the duration of the victims' inability to fulfil their usual activities and is determined by physicians. Professional guidelines from the French National Authority for Health indicate that TIW applies both to physical and psychological problems. The law of 9 July 2010 makes explicit reference to TIW in cases of psychological violence and intimate partner harassment. Prosecutors base criminal penalties on the duration of TIW in cases of assault and battery. Whatever the physician, they should describe the mental state of the victim and identify the signs that may indicate the mental impact of reported assaults. Identifying combinations of symptoms can be useful in deciding whether the duration of TIW should be increased because of the psychic state. In case of stalking, assessment of TIW can allow prosecutors to link the reported facts to a criminal offence. In complex situations, the physician may be unable to assess a duration of TIW and can suggest expert assessment. In all cases, the duration of TIW needs to be based on functional criteria. The extent of harm to the life of relationships results from suffered violence, from the victim's reaction, and from the perception of their family and friends. In this area, we suggest to limit the first assessment of TIW to a few days and to reassess it later, according to real information reported by the victims, to careful observation of their behaviour, and to results of a questioning that should be as little suggestive as possible. At either end of the age scale and in case of preexisting functional impairment, assessment of TIW should take into account the actual and global capacity of the person before the assault.

[Access to Assisted Reproductive Technologies, surrogacy, same sex couple parenting]. / L'accès à l'Assistance Médicale à la Procréation, la gestation pour autrui, l'homoparentalité

In France, access to Assisted Reproductive Technologies (ART) is strictly controlled. ART is only authorized for medical infertility. The revision of the law of bioethics has not modified access to ART. It is still forbidden to take charge of lesbian couples or gay-male couples, surrogacy is prohibited. The only change is that unmarried couples have no more to prove they live together since 2 years.

A special kind of married man: notions of marriage and married men in the Swedish gay press, 1954­1986.

There has long been ambivalence in the LGBT movement and related research as to the meaning of gay identity in relation to marriage. The article explores changing homonormative discourses of marriage and married men within the Swedish gay press from the mid 1950s to the mid 1980s. Expressions of the changes are a shift in language and in views of extramarital relationships, openness, and gay male identity. As a result of the shift, "married men," including both "married homosexuals" and "bisexuals," came to be distinguished from "gays."