Journal articles on the topic 'Fertilization in vitro, Human (Islamic law)'

Upon discovery of the In Vitro Fertilization and Embryo Transfer method (IVF-ET), outcomes such as production of a great number of embryos, pre-implantation genetic screening and diagnosis, sex selection and multi-parent IVF have gradually become possible. These developments need to be evaluated in the context of the general principles of Islam as well. Islamic communities have accepted the IVF-ET technology, which allows infertile couples to have children, as an exceptional solution and treatment. Nevertheless over time, the IVF method introduced expansions that contradict with religious, ethical and social values.International Journal of Human and Health Sciences Vol. 02 No. 01 Jan’18. Page : 18-24

The main problem in this research is how the reasons for determining nasab IVF and how is the study of Maqasid al-Shari'ah about nasab ?. This research is classified as research (Librative qualitative research). In answering the existing problems, the authors collected data through documentation by utilizing several books that deal with problems. And then analyzed using descriptive methods of analysis with a deductive mindset that is expressed data in general and then drawn to specifics. The results of this study reveal that there are two ways of making IVF that are justified by religion and fulfill the legal requirements of Islamic law. Namely: 1) Fertilazation in Vitro (FIV) by taking the husband's sperm and wife's ovum then processed in vitro (tube), and after fertilization, then transferred in the wife's uterus. 2) Intra Felopian Tuba Gramet (GIFT) by taking husband's sperm and wife's ovum, and after fertilization occurs, it is immediately planted in the oviduct (fallopian tube). In terms of the Maqasid al-Sharia'h, the text is one of the goals of creating benefit, regularity and expediency to protect offspring. In the perspective of Maqasid as-Shari'ah categorized as al-Muhafadzah ala an-Nasl (maintaining offspring), namely: guaranteeing the sustainability of the human population to stay alive and develop healthy and sturdy, both character and religion.

The advancement of contemporary biomedical issues has brought forth two distinct responses among Muslim scholars. The traditional view, which strictly adheres to the Quran and tradition, tends to find it difficult or even outright rejects modern biomedical practices as they may conflict with religious texts. On the other hand, the rationalist perspective tends to be more open and accommodating towards modern biomedical practices as it relies on independent reasoning detached from revelation. While acknowledging the existence of the traditionalist viewpoint in the modern era, this paper focuses on the rationalist perspective, discussing how biomedical decisions are made. By examining rationalist views on several modern biomedical issues such as organ transplantation, in vitro fertilization, and blood trading, the researcher argues that the flexibility of the maqāsid al-sharīʿah principles has become the framework in the development of this biomedical field. The researcher highlights a shift in the maqāsid paradigm from a theocentric paradigm – interpreting religion with the narrow goal of 'defending God' – to an anthropocentric paradigm – interpreting religion to defend human beings and their rights. Using discourse analysis methodology, this study argues that the paradigm shift towards an anthropocentric maqāsid has integrated Sharia with human subjectivity influenced by interests. Consequently, modern biomedical issues, which address the interests of safeguarding human life, are prioritized. Finally, although such maqāsid may potentially lead to a liquid Islamic law, the researcher concludes that an anthropocentric maqāsid paradigm will be more humane, dynamic, accommodating, and responsive to the demands of human life development. Abstrak: Kemajuan isu-isu biomedis kontemporer saat ini telah memunculkan dua aliran respon yang berbeda di mata para cendekiawan muslim. Pandangan tradisional, yang dengan ketat berpedoman pada Al-Qur’an dan tradisi, cenderung sulit atau bahkan tidak menerima sama sekali praktik-praktik biomedis modern karena bertentangan dengan nash-nash agama. Sementara pandangan rasionalis cenderung lebih terbuka dan akomodatif menerima praktik-praktik biomedis modern karena berpedoman pada penilaian akal sendiri yang terlepas dari wahyu. Terlepas dari mendiskusikan keberadaan pandangan pertama (tradisionalis) di era modern ini, makalah ini akan fokus pada pandangan kedua (rasionalis) dengan mendiskusikan bagaimana putusan-putusan biomedis dikeluarkan. Dengan mengkaji pandangan-pandangan rasionalis terhadap beberapa isu biomedis modern, seperti transplantasi organ, bayi tabung, dan jual beli darah, peneliti berargumen bahwa fleksibilitas prinsip-prinsip maqāsid al-syarīah telah menjadi framework dalam pengembangan bidang biomedis ini. Di sini, peneliti menyoroti adanya pergeseran maqāsid dari paradigma teosentris; menjalankan agama dengan tujuan ‘membela Tuhan’ dalam pengertian yang sempit, ke paradigma antroposentris; menjalankan agama untuk membela manusia dan hak-haknya. Dengan menggunakan metode analisis wacana, penelitian ini berargumen bahwa pergeseran paradigma maqāsid menuju antroposentris telah menjadikan syari’ah menyatu dengan subjektivitas manusia yang dipengaruhi oleh kepentingan-kepentingan. Karenanya, isu-isu biomedis modern, yang menjawab kepentingan menjaga jiwa manusia, adalah diutamakan. Terakhir, meskipun maqāsid seperti ini berpotensi mengarah pada liquid Islamic law, peneliti berkesimpulan bahwa paradigma maqāsid antroposentris akan lebih humanis, dinamis, akomodatif, dan responsif terhadap tuntutan perkembangan kehidupan manusia.

This paper aims to examine the In Vitro Fertilization (IVF) program from the perspective of Islamic law, and positive law in Indonesia, so that it is clear whether the practice of IVF is religious or Indonesian law. In conducting the analysis, the authors use a type of qualitative literature research with a normative approach. The results of this paper are: (1) The artificial insemination program for IVF is permitted in Islamic law, with the condition that the sperm must come from the husband himself. In vitro insemination with the Surrogate Mother's uterus rental model, there are two opinions. The first opinion states that surrogacy is prohibited because it creates a mix of lineages which are also related to mahram and inheritance. The second opinion states that Surrogate Mother is allowed for emergency reasons. (2) Implementation of IVF in Indonesia is regulated in Law Number 36 of 2009 concerning Health. The law regulates the conditions and procedures that must be met to be able to participate in the program so that babies born in the program do not violate ethics in society and religion.

The publication raises issues of interaction of rapidly developing areas of bio-medicine and international legal standards, and national legislation of states. Attention is focused on the need for legal guarantees in the field of editing the genome of living organisms, in vitro fertilization, etc. It is proposed to form a uni-form attitude and establish the boundaries of what is permissible in the field of genetic practice so that the situation does not get out of the control of the human mind.

The present investigation is focused on determining the legal situation of the cryopreserved human embryo in Peruvian civil law from the ruling of the Inter-American Court of Human Rights in the "Case of Artavia Murillo et al. (In vitro fertilization) Vs. Costa Rica", beginning the study of file No. 02005-2009-PA/TC (case of the “Morning After Pill”) and Exp. 30541-2014-0-1801-JR-CI-01 (Amparo that authorizes the free distribution of levonorgestrel), within the framework of legislation and jurisprudence foreign, having as hermeneutical guideline the principle pro homine and pro debilis. It is concluded that the national legal system recognizes the legal status of the cryopreserved human embryo as a person, which contradicts the standard established by the Inter-American Court which excludes it from the scope of Article 4.1 of the Convention.

Abstract Background: The use of embryos in embryonic stem cell research (ESCR) has elicited ethical controversies as it entails the destruction of 5-day old human embryos to harvest stem cells. Objective: To explore the ethical positions of Islam, Buddhism, Hinduism, and Catholicism concerning the use of (1) left-over embryos from in vitro fertilization (IVF) also known as ‘surplus’ embryos and (2) ‘research embryos’ which are created by scientists to conduct research using embryonic stem cells. Methods: The opinions of religious leaders of Buddhist, Hindu, and Catholic faiths in Malaysia pertaining to ESCR were examined via in-depth, semi-structured interviews while Islamic responses are collected from local writings related to the derivation of fatwa on this issue. Participants’ responses on the ethics of human stem cell research are presented as a reflection of various scriptural texts of these four religions. These are presented and supported with the help of international bioethics literature and focus on the use of ‘surplus’ embryos and ‘research’ embryos. Results: Islamic ethics deviate from Hindu and Buddhist teachings regarding saving of research embryos that have been created specifically for research and are considered as human lives only after 120 days fertilization. Hindu and Buddhists also underscore the sanctity of human life, but give priority to the alleviation of suffering in living adult humans. They generally encourage ESCR. Research is a knowledge-seeking endeavor considered noble by Islam. This is also a concept within Hindu and Buddhist philosophy; in particular, when potentially beneficial research goals are the basis. Catholicism also emphasizes sanctity of human life, but stresses also the inviolability of embryos from the moment of conception. Conclusion: Embryonic stem cell research is permissible and encouraged according to Hindu and Buddhist perspectives in view of the potential benefits of such research to society, with some reservations. This is similar to Islamic views on the ethics of ESCR. However, Catholicism differs from all the other three religions; it appears to discourage research in this field because of the likely violation of a sacred principle in Catholic teachings.

The main aim of this article is to analyze the position of Law and Justice party (PiS) towards in vitro fertilization (IVF) at the level of ideological and political agenda, results of parliamentary votes, and views of the electorate. Therefore, the following concepts were analyzed: the Law and Justice party doctrinal stereotype, the party's political stance on IVF, draft bills, the position of the party's club in the parliament towards the aforementioned and the results of parliamentary votes alongside the views of the electorate on IVF. Recognizing that human dignity begins with conception, the Law and Justice party is in favor of banning IVF and imposing criminal punishments for carrying it out, experimenting on embryos, and destroying them. These methods include: qualitative analysis of ideological and political program assumptions, institutional and legal assumptions, quantitative analysis of existing data. In order to determine the position of the party's electorate towards IVF, the announcements of the Public Opinion Research Center (CBOS) were analyzed.

Abstract:Reproductive cloning technology is able to facilitate artificial fertilization by using the husband's body and wife's ovum, as well the embryo transferred to the womb of the wife. So that, human cloning can give benefit to husband and wife to get child. However, human cloning technology has negative implications in case of marriage, jurisprudence, guardianship, inheritance, and investigation of criminal offense, because a person may have children cloned without marital status that can underestimate the institution of marriage. The “Nasab” of cloned child is also unclear, so it affects the guardianship, inheritance, father's responsibility to the child. Therefore, Islamic law in Indonesia prohibits human cloning.Keywords: Human Cloning, Islamic Law, Marriage. Abstrak.Teknologi kloning reproduksi mampu memfasilitasi pembuahan buatan dengan menggunakan sel tubuh suami dan ovum istri, serta embrionya ditransfer ke rahim istri. Sehingga kloning manusia dapat memberikan kemaslahatan terhadap pasangan suami istri yang tidak subur untuk memperoleh keturunan. Namun demikian, teknologi kloning manusia berimplikasi negatif, baik terhadap institusi perkawinan, nasab, perwalian, kewarisan, serta penyelidikan dan penyidikan pelaku tindak pidana. Sebab seseorang bisa punya anak secara kloning tanpa ikatan perkawinan sehingga bisa menyepelekan institusi perkawinan. Nasab anak hasil kloning juga tidak jelas sehingga berpengaruh pada perwalian, kewarisan, tanggungjawab ayah kepada anak dan sebaliknya. Karena itu hukum Islam di Indonesia melarang kloning manusia.Kata Kunci: Kloning Manusia, Hukum Islam, Perkawinan.

More than half a million couple may be suffering from infertility in the world. When in vitro fertilization is unsuccessful, surrogacy may be a substitute choice for many couples. Literature shows that ten million Muslims are infertile worldwide. According to Islamic theology the concept of surrogacy is null and void as formation of blastocyst constitutes from sperm that is transferred to the uterus of a woman who is not married to him. In Islam, marriage is the only legal procedure to procreation for preservation of lineage, inheritance, prevention of adultery and prevention of possibility of incest among the half-siblings. Genetic gestational surrogacy (sperm and ovum of husband and wife is fertilized by IVF procedure and transfer the embryos to the surrogate mother) may be free from social, legal and moral complications. Some Islamic countries have reluctant law in favour of surrogacy, as for example Iran, Lebanon and sporadic parts of the Muslim world. This article has attempted to find out a valid notion for accepting genetic gestational surrogacy in major part of the Muslim world that may reduce the peril of women who can not give a birth baby.

More than half a million couples may be suffering from infertility in the world. When in vitro fertilization is unsuccessful, surrogacy may be a substitute choice for many couples. Literature shows that ten million Muslims are infertile worldwide. According to Islamic theology the concept of surrogacy is null and void as formation of blastocyst constitutes from sperm that is transferred to the uterus of a woman who is not married to him. In Islam, marriage is the only legal procedure to procreation for preservation of lineage, inheritance, prevention of adultery and prevention of possibility of incest among the half-siblings. Genetic gestational surrogacy (sperm of husband and ovum of wife is fertilized by IVF procedure and transfer the embryos to the surrogate mother) may be free from social, legal and moral complications. Some Islamic countries have reluctant law in favour of surrogacy, as for example Iran, Lebanon and sporadic parts of the Muslim world. This article has attempted to find out a valid notion for accepting genetic gestational surrogacy in major part of the Muslim world that may reduce the peril of women who can not give a birth baby.

Lost at times in the heat of debate about stem cell research, or any controversial advanced technology, is the need for precision in debate and discussion. The details matter a great deal, ranging from the need to use words that have precise definitions, to accurately quote colleagues and adversaries, and to cite scientific and medical results in a way that reflects the quality, rigor, and reliability of the work at issue. Regrettably, considerable inaccuracy has found its way into the debates about stem cells, on all sides, with consequent fogging of the issues.A key detail that is often overlooked in the debates about the uses of human embryonic stem cells in research comes from the nature of in vitro fertilization (IVF) treatment for infertility. Specifically, there are many frozen human embryos (more precisely called blastocysts) that are in excess of reproductive needs of the couple who generated them, and that must be either frozen indefinitely, donated to another couple, or destroyed.

In 2008, an amendment was proposed to the Colorado Constitution that sought to attach the rights and protections associated with legal “personhood” to any human being from the moment of fertilization. Although the initiative was defeated, it sparked a nation-wide Personhood Movement that has spurred similar efforts at the federal level and in over a dozen states. Personhood advocates choose terms like “fertilization,” or phrases such as “human being at any stage of development,” to identify the “person”-defining moment in the reproductive process, and these designations have profound implications for reproductive choice. Proponents are outspoken in their desire to outlaw abortion, but they are less transparent about their intent with respect to other aspects of reproductive choice, such as contraception and infertility treatments. This paper describes the background of the Personhood Movement and its attempt to achieve legal protection of the preborn from the earliest moments of biological development. Following the late 2011 failure of the personhood measure in Mississippi, the language used within the Movement was dramatically changed in an attempt to address some of the concerns raised regarding implications for reproductive choice. Putting abortion to one side, this paper identifies why the personhood framework that is contemplated by the proposed changes does not eliminate the potential for restrictions on contraception and in vitro fertilization (IVF) that put the lives of these newly recognized persons at risk; nor should it if proponents intend to remain consistent with their position. The paper goes on to suggest what those restrictions might look like based on recent efforts being proposed at the state level and frameworks that have already been adopted in other countries.

Abstract International and constitutional law, originally distinct realms with limited areas of intersection, are getting closer and closer, particularly in the European landscape within the human rights protection field, where these mere contacts between the two systems have become intersections and overlaps. The present article will try to shed light on the still unsolved and problematic issues to which overlapping human rights protection systems give rise, by focusing on an analysis of the heterologous in vitro fertilization case, where both the Strasbourg Court and the Italian Constitutional Court delivered relevant judgments on very similar matters (ECtHR’s S.H. Judgment; Judgment No. 162/2014 from the Italian CC). Such analysis revealed useful in highlighting connections and disconnections between the different levels of protection of rights, and led us to argue that the development of a multilevel protection of rights is also, at least partially, a tale of Courts, each competing to have the last word on human rights adjudication.

When in vitro fertilization (IVF) treatments first appeared in Hungarian legislation, the related experiences and the moral dilemmas of couples who go through these procedures were unknown. Couples have to make a great variety of decisions during the IVF process. In our study, we focus on the journey of the human embryo in IVF treatment through the ethical lenses of women. In order to explore the differences between established ethical and legal frameworks and the perspectives of women who have participated in an IVF procedure in Hungary, we conducted semi-structured interviews. In contrast to the static view of embryos typical to a part of the ethics literature, which also characterizes most established legal frameworks, patients’ view of embryos of interviewees was dynamic: they interpreted embryos in a malleable and constantly changing way. Embryos were perceived differently depending on time, place, and biological characteristics, and primarily in relation to how they could contribute to achieving the goals of treatment. In this article, we also demonstrate that the main ethical framework that the participants in our research evoked in relation to the IVF process was related to the ethics of medical treatment. At the end of the paper we also make an attempt to draw some conclusions that may help ameliorate problems with the current normative ethical and legal framework by incorporating the experiences of women who participate in IVF procedures.

Islam provides specific guidelines for meat production and consumption based on halal and hygiene laws. This study mainly focuses on the permissibility of emerging lab-cultivated meat from the Shari’ah perspective. It also examines the notion and significance of halal food (especially meat) within the purview of Islamic jurisprudence and assesses the position of lab-grown meat for Muslim consumers. This work further highlights the underlying reasons behind the prohibition of Haram food and it investigates the production process of in vitro meat to see whether it is done in accordance with Shari’ah guidelines. Furthermore, the study explores consumer rights to halal meat within the ambit of the Shari’ah. The objective of this research is to explore this new kind of meat and evaluate its legitimacy under Islamic law. This will hopefully create awareness in Muslim consumers and create an interest among researchers. The research adopts doctrinal research where the researcher consults relevant literature in the form of books, research articles and reports on the views of experts in the subject matter. This leads to the basic conclusion that whilst Islam supports the use of technology to improve human lives, such use needs to correspond to the promotion and protection of the Maqasid al-Shari’ah.

The article deals with the issues of realization of one of the reproductive rights – the use of in vitro fertilization. The right to have children is one of the fundamental constitutional rights. It is emphasized that the use of IVF is a forced measure for spouses (married couples), since it is not possible to conceive children naturally due to medical indications. The point of view that IVF as a result of biomedical advances is becoming more and more predominant; although to a lesser extent, there are voices that have children is a kind of duty to society. It is generally accepted that IVF should not be used to choose the sex of a child, or any of its physical characteristics. This emphasizes the value of the common good, rather than the priority of an individual subject’s choice. The deliberate choice of the sex of an unborn child is a pathway to pernicious gender imbalance. In the context of the moral status of the human embryo, it is recognized that raising an embryo for more than 14 days and then destroying it is ethically unacceptable. Attention is drawn to the disputes arising in practice concerning the possible use of IVF, including after the dissolution of a marriage. Proposals are made to improve civil and other legislation and law enforcement practice. In particular, to provide that heirs under the will and the law may include citizens conceived in accordance with an agreement between a woman and a man to use his biomaterial for in vitro fertilization within six months after his death and born alive after the opening of the inheritance. Free storage of gametes must be provided to law enforcement officers, professional servicemen and servicemen performing duty in «hot spots», employees of the Ministry of Emergency Situations, etc., provided that they do not yet have children. In other cases, they can be kept for a fee.

Resumen:El presente trabajo es un análisis de cómo ha evolucionado la protección del no nacido en España desde la aprobación de la Constitución de 1978. Se centra, en particular en el estudio de la legislación y de la jurisprudencia constitucional sobre dos temas especialmente relevantes y controvertidos: la regulación del aborto, de un lado, y de la fecundación in vitro y uso de embriones, sus tejidos y órganos, de otro. Tanto el legislador como la doctrina del Tribunal Constitucional se han inclinado por una protección gradualista de la vida humana en formación que deja abiertos muchos interrogantes desde la perspectiva del derecho a la vida (art. 15 CE) y la dignidad humana (art. 10.1 CE)Summary:1. The Introduction Of Abortion In Spain And The STC 53/1985: a) From Criminalization To Decriminalization In Certain Circumstances; b) STC 53/1985: i) Right To Life And Prenatal Life; ii) The Life Of The Unborn As A Constitutional Interest; iii) The Constitutionality Of The Indication System; iv) The Conditions For The Constitutionality Of Decriminalization; c) The New Regulation. 2. From The «Indication System» To The «System Of Deadlines»: Organic Law 2/2010 Of 3 March On Sexual And Reproductive Health And Voluntary Termination Of Pregnancy: a) The Evolution Of Abortion In Spain Under The 1985 Act;b) The Arguments For The Reform And The Context Of The New Regulation;c) The New Regulation. 3. An Open Debate: a) The Conditions For The Constitutionality Of Decriminalization; b) The Failed Reform Of The Act. 4. The Weak Protection Of The Embryo In The Legislation On In Vitro Fertilization And The Use Of Embryonic Organs And Tissues, And The SSTC 212/1996 And 116/1999: a) Act 35/1988 On Assisted Reproduction Techniques, And Act 42/1988 On Donation And Use Of Human Embryos And Fetuses And Their Cells, Tissues And Organs; b) Negation Of The Right To Life Of The Embryo And Consequences For Its Consideration As A Constitutionally Protected Legal Interest: i) The Embryo Does Not Hold The Right To Life; ii) Two New Categories:Pre-Embryos And Non-Viable Embryos And Their Legal Relevance; iii) Surplus Embryos; iv) The Absence Of Any Criminal Protection; v) A Weak Concept Of Dignity. 5. Legislative Evolution; 6. A Model For The Gradual (Dis)Protection Of Unborn Human Life.Abstract:This paper analyzes the evolution of the protection of the unborn human life in Spain since the enactment of the 1978 Constitution. It focuses, in particular, on the study of the laws and the constitutional jurisprudence on two relevant matters: the regulation of abortion; and the in vitro fertilization, the use of embryos their tissues and organs. The legislator and the decisions of the Constitutional Court have opted for gradualist protection of the embryo that leaves many questions open from the perspective of the right to life (Article 15 SC) and human dignity (Article 10.1 SC).

The Human Fertilisation and Embryology Act of the United Kingdom was passed in 1990, leading to the formation of the Human Fertilisation and Embryology Authority (HFEA), the first statutory body to regulate and control assisted conception anywhere in the world. The principal function of the HFEA is to license and monitor clinics that carry out in vitro fertilization (IVF), donor insemination (DI), and embryo research. Information on over 135,000 treatment cycles, 20,000 pregnancies, and 25,000 babies following IVF has now been collected as part of the regulatory process, and these data have permitted unbiased and accurate evaluation of treatment efficacy using pregnancy and live-birth rates. The treating clinics are required by law to provide information on the outcome of all births, including neonatal mortality and congenital malformations, but there is no systematic validation of these data using medical records or any follow-up of treated women, or babies, over time. In addition, the strict confidentiality of data supplied to the HFEA means that outside researchers have been unable to access the database for research projects. Thus, at the present time, it is not possible to evaluate the long-term safety of assisted conception procedures using HFEA data. There is reasonable scientific evidence to justify full investigation of the health of both treated women and resulting children. Particular health outcomes requiring evaluation include obstetric complications, preterm births, cerebral palsy, and cancer. The HFEA has recognized the need for follow-up studies and is currently investigating ways of enabling research projects using HFEA data to be undertaken.

Contemporary medicine offers more and more possibilities as far as procreation is concerned. They are available, first of all, to infertile couples (IVF – In Vitro Fertilization). However, the advanced reproductive technology is also used by people who are biologically capable of having children. These people are ready to resign voluntarily from pregnancy and childbirth difficulties. The surrogate motherhood appears as a phenomenon known already from biblical times but existing nowadays in a different context. At the same time, some issues are emerging – questions concerning social, ethical, moral and legal consequences. This paper presents the issue of surrogate motherhood in the context of social changes, which could lead to a development of such practices as well as the reasons of parents and surrogate mothers. Can this phenomenon be perceived as a service for people who want to fulfill their desires for having children? Would surrogate motherhood become a socially approved practice? What are the ethical, religious and legal norms concerning this phenomenon? The religious norms are connected, first of all, with an attitude of the Catholic Church which recognizes surrogacy as unacceptable and states that “it offends the dignity and the right of a child to be conceived, carried in the womb, delivered to the world and brought up by their own parents”. The ethical norms refer to the biotechnological issues and include matters of creating and implanting human embryos as well as the problem of the surrogate mother – child – biological parents relationship. As far as legal norms are concerned, the case is still open hence Polish law does not take into consideration in vitro fertilization or the admissibility of surrogate motherhood.

The world of assisted reproductive technologies (ART) has forced our society to confront scenarios that were unimaginable a mere quarter century ago. The birth of Louise Brown in 1978, the first child conceived through in vitro fertilization (IVF), introduced to the world the notion of asexual reproduction. The bitter battle over the parental status of Baby M., a baby born by a surrogate mother in the early 1980s, engendered a public debate over the interaction between contract law, family law and reproductive liberties that still rages today. In 1992, the highly publicized divorce of Junior and Mary Sue Davis focused national attention on the issue of proper disposition of frozen embryos. This case highlighted the fact that conception and pregnancy could be separated by a significant amount of time as a result of cryopreservation. While each of these events marked a step forward in the march toward total technological mastery of human reproduction, they also suggest that future struggles involving ART will grow increasingly fierce and complicated as our fund of knowledge increased. This Article suggests that current disputes over the disposition of frozen embryos are emblematic of that struggle.

The article examines modern aspects of the legal regulation of artificial intelligence through the prism of the use of reproductive technologies. It is noted that the legal regulation of artificial intelligence is carried out both at the national and international levels. In Ukraine, the issue of artificial intelligence is partially regulated in the Law of Ukraine "On the Protection of Personal Data" and the Concept of the Development of Artificial Intelligence in 2020. The international legal regulation of this aspect of social relations is concentrated in international acts that have a purely advisory nature regarding the characteristics of artificial intelligence, in particular in the European Ethical Charter of the Council of Europe regarding the use of artificial intelligence in judicial systems. It was emphasized that on the issues of artificial reproduction, where artificial intelligence acts as a "mother". The concept of artificial reproduction involves the widespread use of artificial intelligence, which will be responsible for each child's access to nutrients "adapted to its needs." In addition, it predicts that artificial intelligence will be able to monitor the development of children and signal any possible deviations. It was concluded that the legal support of artificial intelligence should be regulated taking into account the study of the risks of its use in various spheres of life of society based on the positive foreign experience of countries such as Japan, Australia, and the USA. At the same time, it is worth taking into account the fact that the role of artificial intelligence in artificial reproduction differs depending on the method. Thus, in the procedure of in vitro fertilization or artificial insemination, artificial intelligence will be involved in the selection process of eggs and sperm in order to increase the percentage of the possibility of fertilization and reduce the risks associated with the development of the embryo. Considered aspects determination the age limit for persons to whom will apply assisted reproductive technology. Also investigated the possibility of reproductive technologies for people who are not in a registered marriage. This article gives examples of legal regulation of assisted reproductive technology in foreign countries.

The article considers the main achievements in the field of genetic engineering and biomedicine in the context of formation of the concept of legal regulation of relations in question. The article considers the issues of applying the human DNA editing technology considered by the Nuffield Council on Bioethics in July 2018. The author substantiates the necessity of determining the legal status of the embryo for its use in clinical trials of gene modifications. The paper considers the risks regarding the use of genetic engineering in relation to the person associated with the possibility of social inequality in the society, application of eugenistic approaches, and the probability of selecting the quality characteristics of embryos by parents resorting to in vitro fertilization. The author concludes that it is necessary to form national and international legislation that will protect the rights and legitimate interests of all subjects and will exclude circumvention of the law and abuse of the right. In addition, it is important to ensure international and public control over the use of the latest advances in genetic engineering and biomedicine prior to conducting clinical trials on humans.

Genetic technologies are rapidly developing, which is not the case for the normative consolidation of scientific achievements and opportunities. The science aimed at improving the quality of life of people is already able to prevent many hereditary disorders by removing the «wrong» gene from the embryo DNA. Editing the human genome is not the future, but the present.It is assumed that legalization in the area of the human genome editing for preventive or therapeutic purposes is more than possible. The article analyzes the issues of the right to go to court on the ground of legal relations that arise when the human embryo genome is edited during the procedure of in-vitro fertilization (IVF) and subsequently a «genetically modified» child is born.Due to the lack of detailed legal regulation of the IVF procedure, scientific research on human embryos and genome editing technology, the author does not exclude situations when successful research can be carried out as well as errors can be committed. In the latter case, it is possible to work upon «healthy» DNA elements instead of or together with «sick» elements, which endangers the life and health of not only the potential person, but also his discendants.Given that the current legislation does not determine the status of a human embryo and establishes the moment of birth as the moment of capacity, while the civil procedural capacity (that is one of the prerequisites for the right to go to a court) of an individual coincides with civil legal capacity, the future human life is deprived of any legal protection. For the same reason, other persons may not go to court in the interests of the unborn child. The article attempts to find a way out of this situation by analyzing Russian and international legislation, as well as the ECHR case law.

INTRODUCTION: Assisted reproduction technologies (ART) are technologies that are used today, in the treatment of infertility, on human germ cells (oocytes and sperm) and embryos. Currently in the Republic of Serbia, there are various procedures of assisted reproduction technologies that are used to treat infertility in patients depending on medical indications. The availability of assisted reproduction technologies has been evolving over the years, and their application differs in biomedically assisted fertilization centers that are in the Network Plan (state institutions) and outside the Network Plan (private institutions). The aim of this article is to analyze available ART methods in Fertility centers within and outside the Network plan regulated by the Law on the Treatment of Infertility Procedures of Biomedical Assisted Fertilization (Official Gazette of the Republic of Serbia", No. 72/2009), their financing and availability to patients in the Republic of Serbia. METHOD:This article is assembled upon seeking documents using the Internet and based on analyzed literature available on the Internet. RESULTS: The results were gathered by analyzing official ART centers' websites and analyzing available external secondary data from the National health insurance fund and the Institute for public health "Dr Milan Jovanovic Batut". Fertility clinics in the Republic of Serbia have access to all the important technologies for ART. ART technologies funded by National health insurance fund include in vitro fertilitation, intracytoplasmic sperm injection and frozen embryo transfer. Patients whose medical indications require for some other technology may approach Fertility Centers outside the Network plan on their own budget. CONCLUSION: Based on the available and updated data we can conclude that Fertility centers in the Republic of Serbia have access to all the important technologies for ART. Fertility centers within the Network plan can implement only the technologies financed and invoiced by the Fund.

The article analyzes the positions of scientists, as well as the current legislation regarding the definition of the beginning of human life in the context of child conception and ensuring the right of human embryo for life. The problem has not only theoretical, but also important practical significance, as the grounds and limits of legal regulation of a number of relations depend on it. The definition of the beginning of life allows for optimal legal regulation, including the provision of legal guarantees to preserve the life of the human embryo. States independently decide on the establishment of prohibition on artificial termination of pregnancy or the time limits after which such a termination is prohibited. Attention is drawn to the development of assisted reproductive technologies, the emergence of the possibility to use cryopreserved embryos, which can be stored for a long time. There is a lack of development of this aspect in science and a small and heterogeneous judicial practice. According to the author, the use of cryopreserved embryos in resolving issues of inheritance of property, as well as after divorce, should be based on a contractual basis. Due to the fact that the legislation allows artificial termination of pregnancy up to a certain period, as well as on medical grounds, the best way to determine the legal capacity of the embryo (foetus) as conditional. Proposals are being made to improve the norms of civil law, including a proposal to call to inheritance for children born as a result of the use of the biomaterial of the testator for in vitro fertilization within six months after testator’s death and born alive after the opening of the inheritance.

Marriage is a social institution. Couples may have their own children via procreation, in the standard course of nature. Unfortunately, infertile couples are unable to have children. The infertility may be either medical or social. There is an underlying urge in every human being to produce biological descendants who will carry on their lineage in society. Although, a barren couple has the task of learning to cope with their lack of children both internally and externally. As a result, they believe they must turn to artificial insemination, in vitro fertilization, test-tube babies, as well as surrogacy, amongst other methods, in order to ensure their survival in society. These methods brighten their eyes and satisfy their yearning for genetically identical offspring. These advancements have aided infertile couples and adults in overcoming reproduction difficulties caused by infertility, such as medical reasons, the loss of a spouse, being separated, homosexual couples, or gay couples, among other things. Through this paper, I would like to enlighten on surrogacy. Here we would discuss various aspects like meaning, method, types, socio-legal, ethical issues, and various reproductive techniques. In modern age surrogacy is very popular in the whole world. Therefore, surrogacy is a highly sensitive and delicate issue. Indeed, it is high time to enact a law to regulate surrogacy in India. The present paper is totally based on secondary sources of data such as legal journals, books, magazines, newspapers and websites sources etc.

The jurisprudential concept of ‘necessity,’ which had its origins in the criminal aspects of both Common Law and Islamic Law, is becoming increasingly important in medical law, especially in relation to organ transplantation, therapeutic cloning, and in vitro fertilisation techniques. Criminal aspects remain closely related to the further concept of ‘duress’ (vitiation of free will) and civil/medical aspects to that of ‘proportionality’ (that the deviation from a norm must be related to the benefit obtained). This paper attempts to examine attitudes of Common Law and Islamic Law to these issues, after some preliminary remarks as to the difficulties and dangers of generalisation. However it may be confidently affirmed that the concepts of necessity and proportionality are well embedded in both systems. Notably also, in both systems there is an abhorrence of commercial transactions involving body parts. There are divergences however - Common Law, broadly, allows any sort of transplantation, for example for cosmetic reasons, whereas as Islam regards this as essential only for the saving of life. In respect of therapeutic cloning there appears to be little divergence of views. In respect of in vitro fertilization, in all Common Law jurisdictions non-spousal sperm donors, anonymous or otherwise, are freely available, and may indeed be paid, whereas in Islam the spousal father must also be the biological father. It is a novelty of the modern world, however, that in almost all countries, even those with a majority Muslim population (like Malaysia) secular law allows freedom of choice so that involvement in these modern medical techniques devolves on personal morality.

<p align="center"><strong>ABSTRACT</strong></p><p><em>Usul Fiqh is a branch of science that until now the benchmark in the process istinbath Islamic law. If traced its history, we all know that the birth, growth and development of Usul Fiqh legal problems began when Muslims dynamics continue to evolve with the times. Hence, the necessary process of Ijtihad, to give a definite legal status of the legal problems at the time of the Prophet Muhammad was not found practical, and yet thrive in this modern era. The practice of marriage through a video conference, euthanasia, in vitro fertilization, cloning humans, a few of the many problems facing people today, which requires rule of law so that the Muslim community is maintained their religiousity from the things forbidden by Allah May He be elevated. Of the many objects in the study of Usul Fiqh, Studies on dalalah an interesting study once seized the attention of students of Islamic law. Dalalah are actually a lot more load semiotic language debate in the Qur'an and hadith and technical rules, it has strict rules and procedural processes in the context of Islamic law istinbath process. In fact, differences of opinion among Islamic scholars pretty much due to the differences in the language of semiotics in understanding the Qur'an and Hadith. On the basis of these considerations and perspectives, the authors assess the discourse surrounding derivatives dalalah and technical rules becomes very important to know though in its concise approach.</em></p><p><em> </em></p><p><strong>Key Word</strong> : Dalalah, Ushul Fiqh, Semiotic, Ijtihad</p>

Abstract Costa Rica's reputation as a stable democracy and champion of inter-American human rights law makes it both beacon and bellwether for sexual and reproductive rights in the American continent. The Costa Rican government brought cases involving in vitro fertilization and same-sex marriage to the Inter-American Court of Human Rights, which issued historic decisions expanding reproductive and sexual rights across Latin America. In response, a transnational coalition of self-proclaimed pro-life and pro-family organizations has targeted the Organization of American States and its system of inter-American human rights law, calling on the OAS to respect national sovereignty concerning life and family matters. This chapter traces Costa Rica's key role in Latin American sexual and reproductive rights lawfare as well as the resulting backlash.

The right to life is a fundamental attribute of the human being, which must be protected by internal and international legal norms. Moreover, modern legal systems protect life as an absolute right, which obliges every person to respect and protect human life, as well as the right to health, physical and mental integrity of human being. Recently, new medical biotechnologies have been introduced into this broad spectrum of human life through which scientists are actively involved in the emergence of life. This involvement of man nin the creation of life has caused many discussions on moral and legal topics, especially regarding in vitro fertilization and artificially human embryos (in vitro). In the following, we will strive to define the medical, ethical and legal aspects of assisted reproduction technologies that are present in Europe, and especially in the Republic of Moldova. We will carry out a review of different legal practices regarding in vitro fertilization and artificially created embryos, as well as the position of different religions in the field of assisted reproduction. In Republic of Moldova, the IVF method it is successfully practiced since 1995. However, the legal and regulatory frameworks has long had deficiencies thus creating difficulties in the effective use this method. Part of these implementation difficulties have only in 2012 by Law no. 138 on reproductive health and later in 2017 by Order no. 149/23.02.2017 of the Minister of Health of the Republic of Moldova regarding medically assisted reproduction.

Photo ID 158378414 © Eduard Muzhevskyi | Dreamstime.com ABSTRACT There is a debate about the ethical implications of using human embryos in stem cell research, which can be influenced by cultural, moral, and social values. This paper argues for an adaptable framework to accommodate diverse cultural and religious perspectives. By using an adaptive ethics model, research protections can reflect various populations and foster growth in stem cell research possibilities. INTRODUCTION Stem cell research combines biology, medicine, and technology, promising to alter health care and the understanding of human development. Yet, ethical contention exists because of individuals’ perceptions of using human embryos based on their various cultural, moral, and social values. While these disagreements concerning policy, use, and general acceptance have prompted the development of an international ethics policy, such a uniform approach can overlook the nuanced ethical landscapes between cultures. With diverse viewpoints in public health, a single global policy, especially one reflecting Western ethics or the ethics prevalent in high-income countries, is impractical. This paper argues for a culturally sensitive, adaptable framework for the use of embryonic stem cells. Stem cell policy should accommodate varying ethical viewpoints and promote an effective global dialogue. With an extension of an ethics model that can adapt to various cultures, we recommend localized guidelines that reflect the moral views of the people those guidelines serve. BACKGROUND Stem cells, characterized by their unique ability to differentiate into various cell types, enable the repair or replacement of damaged tissues. Two primary types of stem cells are somatic stem cells (adult stem cells) and embryonic stem cells. Adult stem cells exist in developed tissues and maintain the body’s repair processes.[1] Embryonic stem cells (ESC) are remarkably pluripotent or versatile, making them valuable in research.[2] However, the use of ESCs has sparked ethics debates. Considering the potential of embryonic stem cells, research guidelines are essential. The International Society for Stem Cell Research (ISSCR) provides international stem cell research guidelines. They call for “public conversations touching on the scientific significance as well as the societal and ethical issues raised by ESC research.”[3] The ISSCR also publishes updates about culturing human embryos 14 days post fertilization, suggesting local policies and regulations should continue to evolve as ESC research develops.[4] Like the ISSCR, which calls for local law and policy to adapt to developing stem cell research given cultural acceptance, this paper highlights the importance of local social factors such as religion and culture. I. Global Cultural Perspective of Embryonic Stem Cells Views on ESCs vary throughout the world. Some countries readily embrace stem cell research and therapies, while others have stricter regulations due to ethical concerns surrounding embryonic stem cells and when an embryo becomes entitled to moral consideration. The philosophical issue of when the “someone” begins to be a human after fertilization, in the morally relevant sense,[5] impacts when an embryo becomes not just worthy of protection but morally entitled to it. The process of creating embryonic stem cell lines involves the destruction of the embryos for research.[6] Consequently, global engagement in ESC research depends on social-cultural acceptability. a. US and Rights-Based Cultures In the United States, attitudes toward stem cell therapies are diverse. The ethics and social approaches, which value individualism,[7] trigger debates regarding the destruction of human embryos, creating a complex regulatory environment. For example, the 1996 Dickey-Wicker Amendment prohibited federal funding for the creation of embryos for research and the destruction of embryos for “more than allowed for research on fetuses in utero.”[8] Following suit, in 2001, the Bush Administration heavily restricted stem cell lines for research. However, the Stem Cell Research Enhancement Act of 2005 was proposed to help develop ESC research but was ultimately vetoed.[9] Under the Obama administration, in 2009, an executive order lifted restrictions allowing for more development in this field.[10] The flux of research capacity and funding parallels the different cultural perceptions of human dignity of the embryo and how it is socially presented within the country’s research culture.[11] b. Ubuntu and Collective Cultures African bioethics differs from Western individualism because of the different traditions and values. African traditions, as described by individuals from South Africa and supported by some studies in other African countries, including Ghana and Kenya, follow the African moral philosophies of Ubuntu or Botho and Ukama, which “advocates for a form of wholeness that comes through one’s relationship and connectedness with other people in the society,”[12] making autonomy a socially collective concept. In this context, for the community to act autonomously, individuals would come together to decide what is best for the collective. Thus, stem cell research would require examining the value of the research to society as a whole and the use of the embryos as a collective societal resource. If society views the source as part of the collective whole, and opposes using stem cells, compromising the cultural values to pursue research may cause social detachment and stunt research growth.[13] Based on local culture and moral philosophy, the permissibility of stem cell research depends on how embryo, stem cell, and cell line therapies relate to the community as a whole. Ubuntu is the expression of humanness, with the person’s identity drawn from the “’I am because we are’” value.[14] The decision in a collectivistic culture becomes one born of cultural context, and individual decisions give deference to others in the society. Consent differs in cultures where thought and moral philosophy are based on a collective paradigm. So, applying Western bioethical concepts is unrealistic. For one, Africa is a diverse continent with many countries with different belief systems, access to health care, and reliance on traditional or Western medicines. Where traditional medicine is the primary treatment, the “’restrictive focus on biomedically-related bioethics’” [is] problematic in African contexts because it neglects bioethical issues raised by traditional systems.”[15] No single approach applies in all areas or contexts. Rather than evaluating the permissibility of ESC research according to Western concepts such as the four principles approach, different ethics approaches should prevail. Another consideration is the socio-economic standing of countries. In parts of South Africa, researchers have not focused heavily on contributing to the stem cell discourse, either because it is not considered health care or a health science priority or because resources are unavailable.[16] Each country’s priorities differ given different social, political, and economic factors. In South Africa, for instance, areas such as maternal mortality, non-communicable diseases, telemedicine, and the strength of health systems need improvement and require more focus[17] Stem cell research could benefit the population, but it also could divert resources from basic medical care. Researchers in South Africa adhere to the National Health Act and Medicines Control Act in South Africa and international guidelines; however, the Act is not strictly enforced, and there is no clear legislation for research conduct or ethical guidelines.[18] Some parts of Africa condemn stem cell research. For example, 98.2 percent of the Tunisian population is Muslim.[19] Tunisia does not permit stem cell research because of moral conflict with a Fatwa. Religion heavily saturates the regulation and direction of research.[20] Stem cell use became permissible for reproductive purposes only recently, with tight restrictions preventing cells from being used in any research other than procedures concerning ART/IVF. Their use is conditioned on consent, and available only to married couples.[21] The community's receptiveness to stem cell research depends on including communitarian African ethics. c. Asia Some Asian countries also have a collective model of ethics and decision making.[22] In China, the ethics model promotes a sincere respect for life or human dignity,[23] based on protective medicine. This model, influenced by Traditional Chinese Medicine (TCM), [24] recognizes Qi as the vital energy delivered via the meridians of the body; it connects illness to body systems, the body’s entire constitution, and the universe for a holistic bond of nature, health, and quality of life.[25] Following a protective ethics model, and traditional customs of wholeness, investment in stem cell research is heavily desired for its applications in regenerative therapies, disease modeling, and protective medicines. In a survey of medical students and healthcare practitioners, 30.8 percent considered stem cell research morally unacceptable while 63.5 percent accepted medical research using human embryonic stem cells. Of these individuals, 89.9 percent supported increased funding for stem cell research.[26] The scientific community might not reflect the overall population. From 1997 to 2019, China spent a total of $576 million (USD) on stem cell research at 8,050 stem cell programs, increased published presence from 0.6 percent to 14.01 percent of total global stem cell publications as of 2014, and made significant strides in cell-based therapies for various medical conditions.[27] However, while China has made substantial investments in stem cell research and achieved notable progress in clinical applications, concerns linger regarding ethical oversight and transparency.[28] For example, the China Biosecurity Law, promoted by the National Health Commission and China Hospital Association, attempted to mitigate risks by introducing an institutional review board (IRB) in the regulatory bodies. 5800 IRBs registered with the Chinese Clinical Trial Registry since 2021.[29] However, issues still need to be addressed in implementing effective IRB review and approval procedures. The substantial government funding and focus on scientific advancement have sometimes overshadowed considerations of regional cultures, ethnic minorities, and individual perspectives, particularly evident during the one-child policy era. As government policy adapts to promote public stability, such as the change from the one-child to the two-child policy,[30] research ethics should also adapt to ensure respect for the values of its represented peoples. Japan is also relatively supportive of stem cell research and therapies. Japan has a more transparent regulatory framework, allowing for faster approval of regenerative medicine products, which has led to several advanced clinical trials and therapies.[31] South Korea is also actively engaged in stem cell research and has a history of breakthroughs in cloning and embryonic stem cells.[32] However, the field is controversial, and there are issues of scientific integrity. For example, the Korean FDA fast-tracked products for approval,[33] and in another instance, the oocyte source was unclear and possibly violated ethical standards.[34] Trust is important in research, as it builds collaborative foundations between colleagues, trial participant comfort, open-mindedness for complicated and sensitive discussions, and supports regulatory procedures for stakeholders. There is a need to respect the culture’s interest, engagement, and for research and clinical trials to be transparent and have ethical oversight to promote global research discourse and trust. d. Middle East Countries in the Middle East have varying degrees of acceptance of or restrictions to policies related to using embryonic stem cells due to cultural and religious influences. Saudi Arabia has made significant contributions to stem cell research, and conducts research based on international guidelines for ethical conduct and under strict adherence to guidelines in accordance with Islamic principles. Specifically, the Saudi government and people require ESC research to adhere to Sharia law. In addition to umbilical and placental stem cells,[35] Saudi Arabia permits the use of embryonic stem cells as long as they come from miscarriages, therapeutic abortions permissible by Sharia law, or are left over from in vitro fertilization and donated to research.[36] Laws and ethical guidelines for stem cell research allow the development of research institutions such as the King Abdullah International Medical Research Center, which has a cord blood bank and a stem cell registry with nearly 10,000 donors.[37] Such volume and acceptance are due to the ethical ‘permissibility’ of the donor sources, which do not conflict with religious pillars. However, some researchers err on the side of caution, choosing not to use embryos or fetal tissue as they feel it is unethical to do so.[38] Jordan has a positive research ethics culture.[39] However, there is a significant issue of lack of trust in researchers, with 45.23 percent (38.66 percent agreeing and 6.57 percent strongly agreeing) of Jordanians holding a low level of trust in researchers, compared to 81.34 percent of Jordanians agreeing that they feel safe to participate in a research trial.[40] Safety testifies to the feeling of confidence that adequate measures are in place to protect participants from harm, whereas trust in researchers could represent the confidence in researchers to act in the participants’ best interests, adhere to ethical guidelines, provide accurate information, and respect participants’ rights and dignity. One method to improve trust would be to address communication issues relevant to ESC. Legislation surrounding stem cell research has adopted specific language, especially concerning clarification “between ‘stem cells’ and ‘embryonic stem cells’” in translation.[41] Furthermore, legislation “mandates the creation of a national committee… laying out specific regulations for stem-cell banking in accordance with international standards.”[42] This broad regulation opens the door for future global engagement and maintains transparency. However, these regulations may also constrain the influence of research direction, pace, and accessibility of research outcomes. e. Europe In the European Union (EU), ethics is also principle-based, but the principles of autonomy, dignity, integrity, and vulnerability are interconnected.[43] As such, the opportunity for cohesion and concessions between individuals’ thoughts and ideals allows for a more adaptable ethics model due to the flexible principles that relate to the human experience The EU has put forth a framework in its Convention for the Protection of Human Rights and Dignity of the Human Being allowing member states to take different approaches. Each European state applies these principles to its specific conventions, leading to or reflecting different acceptance levels of stem cell research. [44] For example, in Germany, Lebenzusammenhang, or the coherence of life, references integrity in the unity of human culture. Namely, the personal sphere “should not be subject to external intervention.”[45] Stem cell interventions could affect this concept of bodily completeness, leading to heavy restrictions. Under the Grundgesetz, human dignity and the right to life with physical integrity are paramount.[46] The Embryo Protection Act of 1991 made producing cell lines illegal. Cell lines can be imported if approved by the Central Ethics Commission for Stem Cell Research only if they were derived before May 2007.[47] Stem cell research respects the integrity of life for the embryo with heavy specifications and intense oversight. This is vastly different in Finland, where the regulatory bodies find research more permissible in IVF excess, but only up to 14 days after fertilization.[48] Spain’s approach differs still, with a comprehensive regulatory framework.[49] Thus, research regulation can be culture-specific due to variations in applied principles. Diverse cultures call for various approaches to ethical permissibility.[50] Only an adaptive-deliberative model can address the cultural constructions of self and achieve positive, culturally sensitive stem cell research practices.[51] II. Religious Perspectives on ESC Embryonic stem cell sources are the main consideration within religious contexts. While individuals may not regard their own religious texts as authoritative or factual, religion can shape their foundations or perspectives. The Qur'an states: “And indeed We created man from a quintessence of clay. Then We placed within him a small quantity of nutfa (sperm to fertilize) in a safe place. Then We have fashioned the nutfa into an ‘alaqa (clinging clot or cell cluster), then We developed the ‘alaqa into mudgha (a lump of flesh), and We made mudgha into bones, and clothed the bones with flesh, then We brought it into being as a new creation. So Blessed is Allah, the Best of Creators.”[52] Many scholars of Islam estimate the time of soul installment, marked by the angel breathing in the soul to bring the individual into creation, as 120 days from conception.[53] Personhood begins at this point, and the value of life would prohibit research or experimentation that could harm the individual. If the fetus is more than 120 days old, the time ensoulment is interpreted to occur according to Islamic law, abortion is no longer permissible.[54] There are a few opposing opinions about early embryos in Islamic traditions. According to some Islamic theologians, there is no ensoulment of the early embryo, which is the source of stem cells for ESC research.[55] In Buddhism, the stance on stem cell research is not settled. The main tenets, the prohibition against harming or destroying others (ahimsa) and the pursuit of knowledge (prajña) and compassion (karuna), leave Buddhist scholars and communities divided.[56] Some scholars argue stem cell research is in accordance with the Buddhist tenet of seeking knowledge and ending human suffering. Others feel it violates the principle of not harming others. Finding the balance between these two points relies on the karmic burden of Buddhist morality. In trying to prevent ahimsa towards the embryo, Buddhist scholars suggest that to comply with Buddhist tenets, research cannot be done as the embryo has personhood at the moment of conception and would reincarnate immediately, harming the individual's ability to build their karmic burden.[57] On the other hand, the Bodhisattvas, those considered to be on the path to enlightenment or Nirvana, have given organs and flesh to others to help alleviate grieving and to benefit all.[58] Acceptance varies on applied beliefs and interpretations. Catholicism does not support embryonic stem cell research, as it entails creation or destruction of human embryos. This destruction conflicts with the belief in the sanctity of life. For example, in the Old Testament, Genesis describes humanity as being created in God’s image and multiplying on the Earth, referencing the sacred rights to human conception and the purpose of development and life. In the Ten Commandments, the tenet that one should not kill has numerous interpretations where killing could mean murder or shedding of the sanctity of life, demonstrating the high value of human personhood. In other books, the theological conception of when life begins is interpreted as in utero,[59] highlighting the inviolability of life and its formation in vivo to make a religious point for accepting such research as relatively limited, if at all.[60] The Vatican has released ethical directives to help apply a theological basis to modern-day conflicts. The Magisterium of the Church states that “unless there is a moral certainty of not causing harm,” experimentation on fetuses, fertilized cells, stem cells, or embryos constitutes a crime.[61] Such procedures would not respect the human person who exists at these stages, according to Catholicism. Damages to the embryo are considered gravely immoral and illicit.[62] Although the Catholic Church officially opposes abortion, surveys demonstrate that many Catholic people hold pro-choice views, whether due to the context of conception, stage of pregnancy, threat to the mother’s life, or for other reasons, demonstrating that practicing members can also accept some but not all tenets.[63] Some major Jewish denominations, such as the Reform, Conservative, and Reconstructionist movements, are open to supporting ESC use or research as long as it is for saving a life.[64] Within Judaism, the Talmud, or study, gives personhood to the child at birth and emphasizes that life does not begin at conception:[65] “If she is found pregnant, until the fortieth day it is mere fluid,”[66] Whereas most religions prioritize the status of human embryos, the Halakah (Jewish religious law) states that to save one life, most other religious laws can be ignored because it is in pursuit of preservation.[67] Stem cell research is accepted due to application of these religious laws. We recognize that all religions contain subsets and sects. The variety of environmental and cultural differences within religious groups requires further analysis to respect the flexibility of religious thoughts and practices. We make no presumptions that all cultures require notions of autonomy or morality as under the common morality theory, which asserts a set of universal moral norms that all individuals share provides moral reasoning and guides ethical decisions.[68] We only wish to show that the interaction with morality varies between cultures and countries. III. A Flexible Ethical Approach The plurality of different moral approaches described above demonstrates that there can be no universally acceptable uniform law for ESC on a global scale. Instead of developing one standard, flexible ethical applications must be continued. We recommend local guidelines that incorporate important cultural and ethical priorities. While the Declaration of Helsinki is more relevant to people in clinical trials receiving ESC products, in keeping with the tradition of protections for research subjects, consent of the donor is an ethical requirement for ESC donation in many jurisdictions including the US, Canada, and Europe.[69] The Declaration of Helsinki provides a reference point for regulatory standards and could potentially be used as a universal baseline for obtaining consent prior to gamete or embryo donation. For instance, in Columbia University’s egg donor program for stem cell research, donors followed standard screening protocols and “underwent counseling sessions that included information as to the purpose of oocyte donation for research, what the oocytes would be used for, the risks and benefits of donation, and process of oocyte stimulation” to ensure transparency for consent.[70] The program helped advance stem cell research and provided clear and safe research methods with paid participants. Though paid participation or covering costs of incidental expenses may not be socially acceptable in every culture or context,[71] and creating embryos for ESC research is illegal in many jurisdictions, Columbia’s program was effective because of the clear and honest communications with donors, IRBs, and related stakeholders. This example demonstrates that cultural acceptance of scientific research and of the idea that an egg or embryo does not have personhood is likely behind societal acceptance of donating eggs for ESC research. As noted, many countries do not permit the creation of embryos for research. Proper communication and education regarding the process and purpose of stem cell research may bolster comprehension and garner more acceptance. “Given the sensitive subject material, a complete consent process can support voluntary participation through trust, understanding, and ethical norms from the cultures and morals participants value. This can be hard for researchers entering countries of different socioeconomic stability, with different languages and different societal values.[72] An adequate moral foundation in medical ethics is derived from the cultural and religious basis that informs knowledge and actions.[73] Understanding local cultural and religious values and their impact on research could help researchers develop humility and promote inclusion. IV. Concerns Some may argue that if researchers all adhere to one ethics standard, protection will be satisfied across all borders, and the global public will trust researchers. However, defining what needs to be protected and how to define such research standards is very specific to the people to which standards are applied. We suggest that applying one uniform guide cannot accurately protect each individual because we all possess our own perceptions and interpretations of social values.[74] Therefore, the issue of not adjusting to the moral pluralism between peoples in applying one standard of ethics can be resolved by building out ethics models that can be adapted to different cultures and religions. Other concerns include medical tourism, which may promote health inequities.[75] Some countries may develop and approve products derived from ESC research before others, compromising research ethics or drug approval processes. There are also concerns about the sale of unauthorized stem cell treatments, for example, those without FDA approval in the United States. Countries with robust research infrastructures may be tempted to attract medical tourists, and some customers will have false hopes based on aggressive publicity of unproven treatments.[76] For example, in China, stem cell clinics can market to foreign clients who are not protected under the regulatory regimes. Companies employ a marketing strategy of “ethically friendly” therapies. Specifically, in the case of Beike, China’s leading stem cell tourism company and sprouting network, ethical oversight of administrators or health bureaus at one site has “the unintended consequence of shifting questionable activities to another node in Beike's diffuse network.”[77] In contrast, Jordan is aware of stem cell research’s potential abuse and its own status as a “health-care hub.” Jordan’s expanded regulations include preserving the interests of individuals in clinical trials and banning private companies from ESC research to preserve transparency and the integrity of research practices.[78] The social priorities of the community are also a concern. The ISSCR explicitly states that guidelines “should be periodically revised to accommodate scientific advances, new challenges, and evolving social priorities.”[79] The adaptable ethics model extends this consideration further by addressing whether research is warranted given the varying degrees of socioeconomic conditions, political stability, and healthcare accessibilities and limitations. An ethical approach would require discussion about resource allocation and appropriate distribution of funds.[80] CONCLUSION While some religions emphasize the sanctity of life from conception, which may lead to public opposition to ESC research, others encourage ESC research due to its potential for healing and alleviating human pain. Many countries have special regulations that balance local views on embryonic personhood, the benefits of research as individual or societal goods, and the protection of human research subjects. To foster understanding and constructive dialogue, global policy frameworks should prioritize the protection of universal human rights, transparency, and informed consent. In addition to these foundational global policies, we recommend tailoring local guidelines to reflect the diverse cultural and religious perspectives of the populations they govern. Ethics models should be adapted to local populations to effectively establish research protections, growth, and possibilities of stem cell research. For example, in countries with strong beliefs in the moral sanctity of embryos or heavy religious restrictions, an adaptive model can allow for discussion instead of immediate rejection. In countries with limited individual rights and voice in science policy, an adaptive model ensures cultural, moral, and religious views are taken into consideration, thereby building social inclusion. While this ethical consideration by the government may not give a complete voice to every individual, it will help balance policies and maintain the diverse perspectives of those it affects. Embracing an adaptive ethics model of ESC research promotes open-minded dialogue and respect for the importance of human belief and tradition. By actively engaging with cultural and religious values, researchers can better handle disagreements and promote ethical research practices that benefit each society. This brief exploration of the religious and cultural differences that impact ESC research reveals the nuances of relative ethics and highlights a need for local policymakers to apply a more intense adaptive model. - [1] Poliwoda, S., Noor, N., Downs, E., Schaaf, A., Cantwell, A., Ganti, L., Kaye, A. D., Mosel, L. I., Carroll, C. B., Viswanath, O., & Urits, I. (2022). Stem cells: a comprehensive review of origins and emerging clinical roles in medical practice. 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International Society for Stem Cell Research. https://www.isscr.org/guidelines/blog-post-title-one-ed2td-6fcdk [5] Concerning the moral philosophies of stem cell research, our paper does not posit a personal moral stance nor delve into the “when” of human life begins. To read further about the philosophical debate, consider the following sources: Sandel M. J. (2004). Embryo ethics--the moral logic of stem-cell research. The New England journal of medicine, 351(3), 207–209. https://doi.org/10.1056/NEJMp048145; George, R. P., & Lee, P. (2020, September 26). Acorns and Embryos. The New Atlantis. https://www.thenewatlantis.com/publications/acorns-and-embryos; Sagan, A., & Singer, P. (2007). The moral status of stem cells. Metaphilosophy, 38(2/3), 264–284. http://www.jstor.org/stable/24439776; McHugh P. R. (2004). Zygote and "clonote"--the ethical use of embryonic stem cells. The New England journal of medicine, 351(3), 209–211. https://doi.org/10.1056/NEJMp048147; Kurjak, A., & Tripalo, A. (2004). The facts and doubts about beginning of the human life and personality. Bosnian journal of basic medical sciences, 4(1), 5–14. https://doi.org/10.17305/bjbms.2004.3453 [6] Vazin, T., & Freed, W. J. (2010). Human embryonic stem cells: derivation, culture, and differentiation: a review. Restorative neurology and neuroscience, 28(4), 589–603. https://doi.org/10.3233/RNN-2010-0543 [7] Socially, at its core, the Western approach to ethics is widely principle-based, autonomy being one of the key factors to ensure a fundamental respect for persons within research. For information regarding autonomy in research, see: Department of Health, Education, and Welfare, & National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1978). The Belmont Report. 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[14] Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A contextually enlightened analysis of three cases. Developing World Bioethics, 22(2), 112–122. https://doi.org/10.1111/dewb.12324 [15] Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A contextually enlightened analysis of three cases. Developing World Bioethics, 22(2), 112–122. https://doi.org/10.1111/dewb.12324 [16] Jackson, C.S., Pepper, M.S. Opportunities and barriers to establishing a cell therapy programme in South Africa. Stem Cell Res Ther 4, 54 (2013). https://doi.org/10.1186/scrt204; Pew Research Center. (2014, May 1). Public health a major priority in African nations. Pew Research Center’s Global Attitudes Project. https://www.pewresearch.org/global/2014/05/01/public-health-a-major-priority-in-african-nations/ [17] Department of Health Republic of South Africa. (2021). Health Research Priorities (revised) for South Africa 2021-2024. National Health Research Strategy. https://www.health.gov.za/wp-content/uploads/2022/05/National-Health-Research-Priorities-2021-2024.pdf [18] Oosthuizen, H. (2013). Legal and Ethical Issues in Stem Cell Research in South Africa. In: Beran, R. (eds) Legal and Forensic Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-32338-6_80, see also: Gaobotse G (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142 [19] United States Bureau of Citizenship and Immigration Services. (1998). Tunisia: Information on the status of Christian conversions in Tunisia. UNHCR Web Archive. https://webarchive.archive.unhcr.org/20230522142618/https://www.refworld.org/docid/3df0be9a2.html [20] Gaobotse, G. (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142 [21] Kooli, C. Review of assisted reproduction techniques, laws, and regulations in Muslim countries. Middle East Fertil Soc J 24, 8 (2020). https://doi.org/10.1186/s43043-019-0011-0; Gaobotse, G. (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142 [22] Pang M. C. (1999). Protective truthfulness: the Chinese way of safeguarding patients in informed treatment decisions. Journal of medical ethics, 25(3), 247–253. https://doi.org/10.1136/jme.25.3.247 [23] Wang, L., Wang, F., & Zhang, W. (2021). Bioethics in China’s biosecurity law: Forms, effects, and unsettled issues. Journal of law and the biosciences, 8(1). https://doi.org/10.1093/jlb/lsab019 https://academic.oup.com/jlb/article/8/1/lsab019/6299199 [24] Wang, Y., Xue, Y., & Guo, H. D. (2022). Intervention effects of traditional Chinese medicine on stem cell therapy of myocardial infarction. Frontiers in pharmacology, 13, 1013740. https://doi.org/10.3389/fphar.2022.1013740 [25] Li, X.-T., & Zhao, J. (2012). Chapter 4: An Approach to the Nature of Qi in TCM- Qi and Bioenergy. In Recent Advances in Theories and Practice of Chinese Medicine (p. 79). InTech. [26] Luo, D., Xu, Z., Wang, Z., & Ran, W. (2021). China's Stem Cell Research and Knowledge Levels of Medical Practitioners and Students. Stem cells international, 2021, 6667743. https://doi.org/10.1155/2021/6667743 [27] Luo, D., Xu, Z., Wang, Z., & Ran, W. (2021). China's Stem Cell Research and Knowledge Levels of Medical Practitioners and Students. Stem cells international, 2021, 6667743. https://doi.org/10.1155/2021/6667743 [28] Zhang, J. Y. (2017). Lost in translation? accountability and governance of Clinical Stem Cell Research in China. Regenerative Medicine, 12(6), 647–656. https://doi.org/10.2217/rme-2017-0035 [29] Wang, L., Wang, F., & Zhang, W. (2021). Bioethics in China’s biosecurity law: Forms, effects, and unsettled issues. Journal of law and the biosciences, 8(1). https://doi.org/10.1093/jlb/lsab019 https://academic.oup.com/jlb/article/8/1/lsab019/6299199 [30] Chen, H., Wei, T., Wang, H. et al. Association of China’s two-child policy with changes in number of births and birth defects rate, 2008–2017. BMC Public Health 22, 434 (2022). https://doi.org/10.1186/s12889-022-12839-0 [31] Azuma, K. Regulatory Landscape of Regenerative Medicine in Japan. Curr Stem Cell Rep 1, 118–128 (2015). https://doi.org/10.1007/s40778-015-0012-6 [32] Harris, R. (2005, May 19). Researchers Report Advance in Stem Cell Production. NPR. https://www.npr.org/2005/05/19/4658967/researchers-report-advance-in-stem-cell-production [33] Park, S. (2012). South Korea steps up stem-cell work. Nature. https://doi.org/10.1038/nature.2012.10565 [34] Resnik, D. B., Shamoo, A. E., & Krimsky, S. (2006). Fraudulent human embryonic stem cell research in South Korea: lessons learned. Accountability in research, 13(1), 101–109. https://doi.org/10.1080/08989620600634193. [35] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6 [36]Association for the Advancement of Blood and Biotherapies. https://www.aabb.org/regulatory-and-advocacy/regulatory-affairs/regulatory-for-cellular-therapies/international-competent-authorities/saudi-arabia [37] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6 [38] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6 Culturally, autonomy practices follow a relational autonomy approach based on a paternalistic deontological health care model. The adherence to strict international research policies and religious pillars within the regulatory environment is a great foundation for research ethics. However, there is a need to develop locally targeted ethics approaches for research (as called for in Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6), this decision-making approach may help advise a research decision model. For more on the clinical cultural autonomy approaches, see: Alabdullah, Y. Y., Alzaid, E., Alsaad, S., Alamri, T., Alolayan, S. W., Bah, S., & Aljoudi, A. S. (2022). Autonomy and paternalism in Shared decision‐making in a Saudi Arabian tertiary hospital: A cross‐sectional study. Developing World Bioethics, 23(3), 260–268. https://doi.org/10.1111/dewb.12355; Bukhari, A. A. (2017). Universal Principles of Bioethics and Patient Rights in Saudi Arabia (Doctoral dissertation, Duquesne University). https://dsc.duq.edu/etd/124; Ladha, S., Nakshawani, S. A., Alzaidy, A., & Tarab, B. (2023, October 26). Islam and Bioethics: What We All Need to Know. Columbia University School of Professional Studies. https://sps.columbia.edu/events/islam-and-bioethics-what-we-all-need-know [39] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics. Research Ethics, 17(2), 228-241. https://doi.org/10.1177/1747016120966779 [40] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics. Research Ethics, 17(2), 228-241. https://doi.org/10.1177/1747016120966779 [41] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East. Nature 510, 189. https://doi.org/10.1038/510189a [42] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East. Nature 510, 189. https://doi.org/10.1038/510189a [43] The EU’s definition of autonomy relates to the capacity for creating ideas, moral insight, decisions, and actions without constraint, personal responsibility, and informed consent. However, the EU views autonomy as not completely able to protect individuals and depends on other principles, such as dignity, which “expresses the intrinsic worth and fundamental equality of all human beings.” Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3 [44] Council of Europe. Convention for the protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine (ETS No. 164) https://www.coe.int/en/web/conventions/full-list?module=treaty-detail&treatynum=164 (forbidding the creation of embryos for research purposes only, and suggests embryos in vitro have protections.); Also see Drabiak-Syed B. K. (2013). New President, New Human Embryonic Stem Cell Research Policy: Comparative International Perspectives and Embryonic Stem Cell Research Laws in France. Biotechnology Law Report, 32(6), 349–356. https://doi.org/10.1089/blr.2013.9865 [45] Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3 [46] Tomuschat, C., Currie, D. P., Kommers, D. P., & Kerr, R. (Trans.). (1949, May 23). Basic law for the Federal Republic of Germany. https://www.btg-bestellservice.de/pdf/80201000.pdf [47] Regulation of Stem Cell Research in Germany. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-germany [48] Regulation of Stem Cell Research in Finland. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-finland [49] Regulation of Stem Cell Research in Spain. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-spain [50] Some sources to consider regarding ethics models or regulatory oversights of other cultures not covered: Kara MA. Applicability of the principle of respect for autonomy: the perspective of Turkey. J Med Ethics. 2007 Nov;33(11):627-30. doi: 10.1136/jme.2006.017400. PMID: 17971462; PMCID: PMC2598110. Ugarte, O. N., & Acioly, M. A. (2014). The principle of autonomy in Brazil: one needs to discuss it ... Revista do Colegio Brasileiro de Cirurgioes, 41(5), 374–377. https://doi.org/10.1590/0100-69912014005013 Bharadwaj, A., & Glasner, P. E. (2012). Local cells, global science: The rise of embryonic stem cell research in India. Routledge. For further research on specific European countries regarding ethical and regulatory framework, we recommend this database: Regulation of Stem Cell Research in Europe. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-europe [51] Klitzman, R. (2006). Complications of culture in obtaining informed consent. The American Journal of Bioethics, 6(1), 20–21. https://doi.org/10.1080/15265160500394671 see also: Ekmekci, P. E., & Arda, B. (2017). Interculturalism and Informed Consent: Respecting Cultural Differences without Breaching Human Rights. Cultura (Iasi, Romania), 14(2), 159–172.; For why trust is important in research, see also: Gray, B., Hilder, J., Macdonald, L., Tester, R., Dowell, A., & Stubbe, M. (2017). Are research ethics guidelines culturally competent? Research Ethics, 13(1), 23-41. https://doi.org/10.1177/1747016116650235 [52] The Qur'an (M. Khattab, Trans.). (1965). Al-Mu’minun, 23: 12-14. https://quran.com/23 [53] Lenfest, Y. (2017, December 8). Islam and the beginning of human life. Bill of Health. https://blog.petrieflom.law.harvard.edu/2017/12/08/islam-and-the-beginning-of-human-life/ [54] Aksoy, S. (2005). Making regulations and drawing up legislation in Islamic countries under conditions of uncertainty, with special reference to embryonic stem cell research. Journal of Medical Ethics, 31:399-403.; see also: Mahmoud, Azza. "Islamic Bioethics: National Regulations and Guidelines of Human Stem Cell Research in the Muslim World." Master's thesis, Chapman University, 2022. https://doi.org/10.36837/ chapman.000386 [55] Rashid, R. (2022). When does Ensoulment occur in the Human Foetus. Journal of the British Islamic Medical Association, 12(4). ISSN 2634 8071. https://www.jbima.com/wp-content/uploads/2023/01/2-Ethics-3_-Ensoulment_Rafaqat.pdf. [56] Sivaraman, M. & Noor, S. (2017). Ethics of embryonic stem cell research according to Buddhist, Hindu, Catholic, and Islamic religions: perspective from Malaysia. Asian Biomedicine,8(1) 43-52. https://doi.org/10.5372/1905-7415.0801.260 [57] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.), Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues (pp. 79-94). Berkeley: University of California Press. https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005 [58] Lecso, P. A. (1991). The Bodhisattva Ideal and Organ Transplantation. Journal of Religion and Health, 30(1), 35–41. http://www.jstor.org/stable/27510629; Bodhisattva, S. (n.d.). The Key of Becoming a Bodhisattva. A Guide to the Bodhisattva Way of Life. http://www.buddhism.org/Sutras/2/BodhisattvaWay.htm [59] There is no explicit religious reference to when life begins or how to conduct research that interacts with the concept of life. However, these are relevant verses pertaining to how the fetus is viewed. ((King James Bible. (1999). Oxford University Press. (original work published 1769)) Jerimiah 1: 5 “Before I formed thee in the belly I knew thee; and before thou camest forth out of the womb I sanctified thee…” In prophet Jerimiah’s insight, God set him apart as a person known before childbirth, a theme carried within the Psalm of David. Psalm 139: 13-14 “…Thou hast covered me in my mother's womb. I will praise thee; for I am fearfully and wonderfully made…” These verses demonstrate David’s respect for God as an entity that would know of all man’s thoughts and doings even before birth. [60] It should be noted that abortion is not supported as well. [61] The Vatican. (1987, February 22). Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation Replies to Certain Questions of the Day. Congregation For the Doctrine of the Faith. https://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html [62] The Vatican. (2000, August 25). Declaration On the Production and the Scientific and Therapeutic Use of Human Embryonic Stem Cells. Pontifical Academy for Life. https://www.vatican.va/roman_curia/pontifical_academies/acdlife/documents/rc_pa_acdlife_doc_20000824_cellule-staminali_en.html; Ohara, N. (2003). Ethical Consideration of Experimentation Using Living Human Embryos: The Catholic Church’s Position on Human Embryonic Stem Cell Research and Human Cloning. Department of Obstetrics and Gynecology. Retrieved from https://article.imrpress.com/journal/CEOG/30/2-3/pii/2003018/77-81.pdf. [63] Smith, G. A. (2022, May 23). Like Americans overall, Catholics vary in their abortion views, with regular mass attenders most opposed. Pew Research Center. https://www.pewresearch.org/short-reads/2022/05/23/like-americans-overall-catholics-vary-in-their-abortion-views-with-regular-mass-attenders-most-opposed/ [64] Rosner, F., & Reichman, E. (2002). Embryonic stem cell research in Jewish law. 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Abstract This article examines the possible effects of the end of a federal constitutional right to abortion on clinical practice and research involving ex vivo human embryos. It first analyzes the likely outcomes of Dobbs v. Mississippi, concluding the Supreme Court will either overrule the federal constitutional abortion right or restrict it in a way that leads to its rapid disappearance. Next, the article discusses a possible increase in use of preimplantation genetic testing as one result. It then forecasts the likely ramifications of such a court decision on state legislation affecting ex vivo human embryos in two ways. It examines the possibility that victory over Roe will inspire embryo support groups to push for limitations on in vitro fertilization, perhaps on its destruction of embryos and more likely on permissible grounds for prospective parents to use in choosing embryos for transfer. It ends by discussing the prospects of new laws in some states banning or limiting research with human embryos.

The development of in vitro fertilization (IVF) in the UK, in 1978, proved a major breakthrough in the process of human reproduction, which had remained constant in human history. The impact of IVF and the ensuing assisted reproductive technologies (ARTs) has not been limited in revolutionizing the "natural" practice of biological reproduction, but has reached out to and affected almost every institution in society. Family and kinship, as the social expression of reproduction and the institutions which are the most transparently structured realm of human life are those most profoundly affected by ARTs. Although literature on the implications of ARTs is in general abundant, this article presents new insights on their impact on family and kinship in Iran, which remains a unique case in the Muslim world. It explores the particular way ARTs, especially third-party donation, have been endorsed and practiced in Iran, and their consequences for the family, the infertile individuals, and their position vis-à-vis their kin and social group. The conclusion points to the lack of clarity concerning the initial rulings by the Islamic jurists, who allowed the practice of ARTs, and which has led to a number of unintended consequences regarding the legal, religious, cultural, and ethical issues, affecting the family, its structure and the relationship between the kin group. These consequences range, inter alia, from the question of the anonymity of third-party donor, to the permissibility of gamete donation between blood relatives, and to the absence of enforceable legislation.

<p><em>In every era, there are always social phenomena that arise, and Islamic law has covered and answered them for their legal position. One of the examples of the phenomena is IVF (In Vitro Fertilization), which is an artificial insemination as a shortcut to get children by bringing together sperm cells and egg cells outside the body which are then inserted into the mother's womb, so they can grow into a fetus as usual pregnancy. In this IVF process, there are likely to be 5 parties involved, namely: husband, wife, sperm donor, ovum donor and uterine mother. If there is a third party besides wife and husband involved in the process of IVF, there will be indications of genetic mixing in the fetus.</em></p><p><em>IVF with a system without any third party involvement (sperm and ovum from husband and wife) by transferring into the womb of the wife is permissible and the baby is the descendant of his parents. However, if there is involvement of a third party, it is prohibited. IVF In the concept of Maqashid Shari'ah is one of the media that contributes in realizing 1. Hifdzu ad-din (protecting religion), 2. Hifdzu an-nafs (protecting souls), 3. Hifdzu al-aql (protecting the mind), 4. Hifdzu al-mal (protecting property), 5. Hifdzu an-nasab (protecting descendants). However, IVF is more dominant and looks more transparent in the aspect of Hifdzu an-nasab (protecting desdendants).</em></p>

The aim. The purpose of this study is based on a study of Ukrainian experience in the field of legal regulation of the use and donating of embryos in vitro for research purposes and infertility treatment, analyzing cases of European Court on human rights in this field, to suggest ways to fill the gaps in current legislation of Ukraine and bring it into line with international law. The subject of the research was the legal regulation of donating embryos for scientific research and for the infertility treatment in Ukraine, which is an interesting experience for scientists from other countries, since Ukraine has become a candidate for European Union (EU) membership, and thus the peculiarities of the legal regulation of embryo donation in Ukraine will allow us to identify the positive and negative aspects of embryo donation and the possibility of conducting a comparative analysis with foreign regulation. In Ukraine, donation of gametes and embryos is a procedure according to which donors, with written voluntary consent, provide their reproductive cells-gametes (sperm, oocytes) or embryos for use in other persons within the treatment of infertility. The application of embryo donation is carried out according to medical indications, subject to the presence of written informed voluntary consent of the patients, ensuring the anonymity of the donor and maintaining medical secrecy. The study is based on an interdisciplinary approach to the analysis of the problem of legal protection of the embryo using dialectical, comparative legal, and systemic methods. The research used scientific developments in the field of problems of the legal status of the human embryo, international acts, the legislation of Ukraine, the practice of the European Court of Human Rights (ECHR). Conclusion. The issue of legal protection of intellectual property rights, the object of which is the human genome, tissues or cells, is currently being hotly debated in the world. However, legal approaches to the possibility of patenting such objects can be divided into those that completely deny the patenting of the human genome, as well as other human tissues and cells, and those that cause such a process of certain restrictions of moral, ethical and legal nature, such as for example, the issue of ensuring the confidentiality of information about the person whose materials are being investigated. It seems that in view of the above practice of the ECHR, it would be appropriate to establish the possibility of free use of the results of such research, which would be in the interests of society and science. Donors of embryos in Ukraine can be patients of the in vitro fertilization program, who have unused cryopreserved embryos left in the cryobank after the birth of a child. In case of fertilization of donor oocytes with donor sperm, their transfer into the recipient's uterine cavity or cryopreservation (with subsequent transfer in subsequent cycles) are possible. With the voluntary, informed, written consent of donor patients, these embryos may be used for donation to an infertile patient/recipient couple, as well as unmarried female recipients. Assignment of embryos and embryo-fetal materials to the category of biological material does not mean that they are subject to the rules of property law, but they should be considered as special objects that are under state protection and are in close legal personal connection with the above mentioned persons, who are given the right to determine their future fate within the limits established by law. The right to dispose of embryos for research purposes may be granted by the woman and the man for whom the embryo was created, subject to informed consent and consent to the processing of personal data.

IntroductionThe choice of trigger drug for the controlled ovarian hyperstimulation (COH) protocol correlates with the outcome of in vitro fertilization/intracytoplasmic sperm injection embryo transfer (IVF/ICSI-ET). The co-administration of gonadotropin releasing hormone agonist (GnRH-a) and human chorionic gonadotropin (hCG), i.e., dual trigger, for final oocyte maturation, has received much attention in recent years. This trial was designed to determine whether a dual trigger approach by lengthening the time between trigger and ovum pick-up (OPU) improves the quantity and quality of mature oocytes/top-quality embryos and pregnancy outcomes in expected normal responders with a high immature oocyte rate.Methods and AnalysisWe propose a study at the Affiliated Hospital of Shandong University of Chinese Medicine. A total of 90 individuals undergoing COH use a fixed GnRH antagonist protocol. They will be assigned randomly into two groups according to the trigger method and timing: recombinant hCG (6500 IU) will be injected only 36 hours before OPU for final oocyte maturation (hCG-only trigger); co-administration of GnRH-a and hCG for final oocyte maturation, 40 and 34 hours prior to OPU, respectively (Dual trigger). The primary outcome is metaphase-II (MII) oocytes rate. Secondary outcomes are number of oocytes retrieved, fertilization rate, top-quality embryos rate, blastula formation rate, embryo implantation rate, clinical pregnancy rate, miscarriage rate, live birth rate, cumulative pregnancy/live birth rates, and ovarian hyperstimulation syndrome (OHSS) rate.Ethics and DisseminationThe reproductive ethics committee of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine certified this study (Identifier: SDUTCM/2021.7.26) as ethical. All individuals will sign written informed consent. All data and biological samples will be protected according to law. The results of this study will be disseminated in a peer-reviewed scientific journal.Clinical Trial Registration[chictr.gov.cn], identifier [ChiCTR2100049292].

Abstract Study question What is the current state of resolving the issue of surplus embryos in Italy, in the absence of clear legislation? Summary answer This paper proposes organic reform of Italian law and European harmonization for informed and conscious patient decision-making on excess embryos. What is known already According to Italian law, embryos obtained through in-vitro fertilization for assisted reproduction that have not reached the transfer phase (including unsuitable ones) cannot be destroyed, resulting in significant resource allocation for indefinite preservation in biobanks. This stems from the legal and ethical recognition of the human embryo as a subject of rights that in turn prohibits destruction, donation to other couples, or use for scientific research. Study design, size, duration My study compares European legal systems and analyzes the evolution of Italian law on medically assisted fertilization (L. 40/2004) since its implementation, with a focus on legal and ethical issues that have been subject of ongoing debate. It also examines the Italian Ministerial Guidelines, the only text where the legislator has dealt with the issue of surplus embryos. Participants/materials, setting, methods Not applicable. Main results and the role of chance The present study examines the various approaches taken by countries to address the issue of surplus embryos. Regulations in countries such as Spain, France were taken into consideration. The British legal system is also examined for its regulations on the donation of embryos and reproductive cells. The Spanish regulation of embryo-sharing (L. 14/2006) is the most organic approach. It grants three options to couples with respect to their remaining embryos: preservation for personal use, donation to other couples, or donation for research. In the United States, the increase in cryopreserved and abandoned blastocysts has led to the spread of conditional embryo adoption and Snowflakes adoption. The Italian provision, however, fails to adequately balance the constitutionally protected interests of couples' self-determination and scientific research for the protection of individual and collective health. Role of chance not applicable here. Limitations, reasons for caution Not applicable. Wider implications of the findings Italian legislation neglecting to intervene has caused numerous issues, such as increased costs for fertility centers and poor practices. Clinics advertising embryo adoption, despite regulatory uncertainty, have created unfair competition leading to psychological distress for couples with cells in limbo and fears of financial obligations. Trial registration number NOT APPLICABLE

The article presents the results of the analysis of family-legal and civil-legal aspects arising from relations in the application of assisted reproductive technologies (hereinafter referred to as ART). The analysis of the legal regulation of germ cell donation, legal problems of anonymity of donors was carried out. The provisions of a number of international acts served as the normative base for the study. These provisions include the final documents adopted at the UN International Conference on Population and Development and the IV UN World Conference on the Status of Women [1, 2]. An analysis of the legislation regulating the use of ART in the Republic of Belarus was carried out. The subject of the research is also the legislative regulation of the use of ART in foreign countries, the works of scientists in the field of medicine and jurisprudence. The studies were carried out on the basis of traditional methods of scientific research of state-legal institutions, the use of methods for interpreting civil law norms contributed to the study of aspects of the topic, the empirical base of the study was the acts of the judiciary on the issues under study, the decisions of the European Court of Human Rights.Important data for the study were obtained through a survey of doctors providing services using ART in Minsk (conducted by the author). To reveal the social attitudes of the use of in vitro fertilization (hereinafter referred to as IVF) among people suffering from infertility, a survey was conducted at the personal request of people suffering from infertility (conducted by the author). The proposals and conclusions formulated in the article can be used in law-making activities aimed at improving the legislation on ART in the Republic of Belarus, as well as in the process of teaching civil and family law of the Republic of Belarus in educational institutions.

Il contributo esamina il “Caso n. 12.361 Gretel Artavia Urilla et Al. vs. Costa Rica” sul quale si attende una pronuncia della Corte interamericana dei diritti umani. La vicenda ha origine dalla sentenza della Corte costituzionale costaricana (del 15 marzo 2000 n. 2000-02306) che aveva annullato, per ragioni di forma e di sostanza, il Decreto Ejecutivo n. 24029-S1 (del 3 febbraio 1995) sulla procreazione artificiale umana. La vicenda prosegue davanti alla Commissione interamericana chiamata in causa da una “Petición” che accusa la Repubblica del Costa Rica di aver violato i diritti di alcune coppie in attesa di realizzare il loro “progetto parentale”. Il divieto di fecondazione artificiale confliggerebbe, in sintesi, con il diritto alla privacy e alla vita familiare, con il diritto di fondare una famiglia con il principio di uguaglianza contenuti nella Convenzione americana dei diritti umani (“Patto di San Josè”). Al termine di un lungo percorso e di un ampio dibattito, la Commissione ha ritenuto che tali diritti fossero stati violati e ha rimesso il caso alla Corte interamericana dei diritti dell’uomo. Con riferimento a questa nuova fase, nell’articolo si dà conto del “Escrito de Amici Curiae” presentato alla Corte dal Movimento per la vita italiano, dall’Istituto di Bioetica, dall’Asociación Crece Familia-CreceFam, dal Coordinamento di Human Life International e da Bioethics Defend Found. Nell’“Escrito” si afferma che il divieto del Costa Rica non viola la Convenzione americana sui diritti umani che afferma: “Ogni persona ha diritto al rispetto della propria vita. Tale diritto è protetto dalla legge e, in generale, è tutelato a partire dal momento del concepimento. Nessuno può essere privato arbitrariamente della vita (art. 4/1). Nel parere, inoltre, si avanzano argomenti di ordine scientifico e giuridico a sostegno del divieto di procreazione artificiale, in nome del riconoscimento della dignità umana e del conseguente diritto alla vita dell’essere umano nella fase più giovane della sua esistenza. Questo diritto, primo fra tutti, è già ampiamente accolto nella Convenzione americana sui diritti dell’uomo sottoscritta e ratificata dalla Repubblica del Costa Rica. ---------- The article deals with the “Case n. 12.361 Gretel Artavia Urilla et Al. vs. Costa Rica” which the Inter-American Court of Human Rights is going to decide. This case has its roots in the Supreme Court of Costa Rica’s decision (n. 2000-02306, March 15, 2000) which annulled the Decree n. 24029-S1 (February, 3, 1995) on human artificial procreation because of both formal and substantial aspects. Indeed, the Supreme Court of the Costa Rica considered that in vitro fertilization constituted a threat against human life before birth. Afterwards, the Inter-American Commission on Human Rights received a “Petición” which charged Costa Rica with a violation of the rights of some couples who wanted to achieve parenthood by medically assisted procreation. In short, according to Petitioner, the ban on in vitro fertilization violated the right to privacy and family life, the right to raise a family and equality before the law and equal protection established in the American Convention on human rights (“Pact of Saint José”). At the end of a long iter and an extended debate, the Inter-American Commission on Human Rights submitted the case to the jurisdiction of the Inter-American Court of Human Rights claiming the violation of said rights and asking the Court to rule and declare the international responsability of the Costa Rican Republic. Regarding this new stage, the article relates the “Escrito de Amici Curiae” sent to the Inter-American Commission on Human Rights by the Italian Movement for the Life, the Institute of Bioethics of teh Catholic University of the Sacred Heart, Asociación Crece Familia-CreceFam, Human Life International and the Bioethics Defense Fund. This “Escrito” argues that Costa Rica’s ban does not violate the American Convention on Human Rights which says that “Every person has the right to have his life respected. This right shall be protected by law and, in general, from the moment of conception. No one shall be arbitrarily deprived of his life” (article 4/1). Besides the “Escrito” presents scientific and legal arguments corroborating the ban on artificial human procreation in the light of modern idea of human rights, recognition of human dignity and the right to life of human beings in the youngest stages of their lives. This right, the primary or first right, is already widely recognized in the American Convention on Human Rights, signed and ratified by Costa Rica’s Republic.

Globally, the increase in human population continues to threaten the sustainability of agricultural systems. Despite the fast-growing population in Sub-Saharan Africa (SSA) and the efforts in improving the productivity of crops, the increase in the yield of crops per unit area is still not promising. The productivity of crops is primarily constrained by inadequate levels of soil nutrients to support optimum crop growth and development. However, smallholder farmers occasionally use fertilizers, and the amount applied is usually small and does not meet plant requirements. This is due to the unaffordability of the cost of fertilizers, which is enough to suffice the crop requirement. Therefore, there is a need for alternative affordable and effective fertilization methods for sustainable intensification and improvement of the smallholder farming system's productivity. This study was designed to evaluate the symbiotic performance of indigenous soybean nodulating rhizobia in selected agricultural soils of Tanzania. In total, 217 rhizobia isolates were obtained from three agroecological zones, i.e., eastern, northern, and southern highlands. The isolates collected were screened for N2 fixing abilities under in vitro (nitrogen-free medium) and screen house conditions. The results showed varying capabilities of isolates in nitrogen-fixing both under in vitro and screen house conditions. Under in vitro experiment, 22% of soybean rhizobia isolates were identified to have a nitrogen-fixing capability on an N-free medium, with the highest N2-fixing diameter of 1.87 cm. In the screen house pot experiment, results showed that soybean rhizobia isolate significantly (P &lt; 0.001) influenced different plant growth and yield components, where the average shoot dry weight ranged from 2.49 to 10.98 g, shoot length from 41 to 125.27 cm whilst the number of leaves per plant ranged from 20 to 66. Furthermore, rhizobia isolates significantly (P = 0.038) increased root dry weight from 0.574 to 2.17 g. In the case of symbiotic parameters per plant, the number of nodules was in the range of 0.33–22, nodules dry weight (0.001–0.137 g), shoot nitrogen (2.37–4.97%), total nitrogen (53.59–6.72 g), and fixed nitrogen (46.878–0.15 g) per plant. In addition, the results indicated that 51.39% of the tested bacterial isolates in this study were ranked as highly effective in symbiosis, suggesting that they are promising as potential alternative biofertilizers for soybean production in agricultural soils of Tanzania to increase productivity per unit area while reducing production cost.

Abstract Study question Does the spatial arrangement of blastomeres and the start of blastulation affect blastocyst quality? Summary answer Better blastocyst quality is associated with the spatial arrangement of the embryo and the shorter time frame of blastulation (cavitation). What is known already The ability to select the human embryo with the highest implantation potential remains one of the greatest challenges in the management of In Vitro Fertilization patients. Several publications have proposed that additional morphological evaluations of blastomere arrangement and the dynamics of late-stage embryonic divisions might be a useful non-invasive way for embryo selection. In the last decade, the introduction of time-lapse technology enables continuous monitoring of embryo development, which leads to better outcomes than a selection based on the traditional morphology assessment. Study design, size, duration The spatial arrangement was defined as tetrahedrally if the cleavage planes were perpendicularly orientated, while embryos with rather parallelly orientated cleavage axes were considered as non-tetrahedral embryos. The injection time of ICSI was designated as “time zero” (t0), and EmbryoViewer software was used to calculate the time duration between injection and start of blastulation (cavitation). Obtained results were later correlated with the embryo’s capability to form a blastocyst as well as with blastocyst quality. Participants/materials, setting, methods A total of 195 oocytes from 40 patients undergoing the antagonist cycle for ICSI treatment were evaluated. All blastocysts were cultured in Embryoscope™ according to the manufacturer’s specifications (Vitrolife, Sweden). The Gardner and Schoolcraft scoring system was used to describe blastocyst quality. Statistical analyses were performed using IBM SPSS version 24. Data were reported as median and range. Differences between groups were tested using the Mann-Whitney U test. Statistical significance was defined as p &lt; 0.05. Main results and the role of chance Obtained data showed that 83.6% (61/73) of embryos with tetrahedral arrangement formed blastocysts compared to 42.4% (50/116) of embryos with the non-tetrahedral arrangement (p &lt; 0,001). Moreover, tetrahedral embryos more frequently formed good quality blastocyst compare to the non-tetrahedral [59% (36/61) vs 18 (9/50)% respectively; p &lt; 0,001]. In addition, we found that good quality blastocyst had a significantly shorter time frame between injection and blastulation start, compared with blastocysts which did not reach good quality [95.00h (84–118) vs 102h (77–121) respectively; p = 0,006]. Limitations, reasons for caution The limitation of the present study was that due to the double-embryo transfer correlation between those morphokinetic parameters and pregnancy rate can not be calculated. Further research should link these morphokinetic parameters with pregnancy rate and live birth rate as well. Wider implications of the findings: The potential of our findings is considerable, especially for countries with strict Embryo Law Regulation. Obtained results might be highly useful for selecting embryos with high implantation potential. In addition, the present work illustrates the possibility of additional information that can potentially be incorporated into an embryo classification model. Trial registration number Not applicable

Abstract Sperm donation has been known to mankind possibly for a very long time, although first medical reports come from the late 18th century. Initially, most inseminations in married couples were homologous, involving the husband’s semen. The first publicized breakthrough that came in 1884 would today be considered unethical, as an anesthetized woman was subjected to an injection of semen from a handsome (as duly reported) student of medicine, without any consent of both her and her spouse. The veil of secrecy that covered heterologous insemination was finally lifted when Dr Mary Barton openly acknowledged the practice in her clinic and published the first manual on “artificial insemination.” It set the ethical standards for such procedures—including mutual anonymity of donors and recipients and maintaining absolute secrecy of the fact of donor insemination—for decades to come. The cost was of course the lost identity of the conceived children and the often reported emotional detachment of the fathers from their social, but not genetical, offspring. The grave consequences of the limited pool of donors were yet to be discovered with the advent of DNA testing. In the UK, Barton’s husband and another collaborator were confirmed to father at least 100 children each. In the Netherlands, the country was shaken by the case of Jan Karbaat who used the sperm of an anonymous donor—who probably should not have even passed psychological screening—to bring more than 200 babies to the world. Suddenly, lots of adults learnt of the existence of their never expected siblings. Concomitantly, more and more parents revealed the fact of donor conception to their children motivated by openness. The secrets could not be held any longer and Joanna Rose was the first British woman that won a court case in 2002 against her own country that was wilfully breaking her right to respect for private and family life guaranteed by European Convention on Human Rights. The proponents of open donation found support also in Convention on the Rights of the Child. More and more countries started enforcing either open or at least double-track donation from then on. However, even more legislations blissfully ignore these ethical developments and maintain complete anonymity of the donor insemination procedures. This is where my personal story begins, as a father of twins born in 2012 from in vitro fertilization thanks to the semen of an anonymous donor. At that time, Poland even did not have an actual law on fertility treatment. The ART centres adopted their own policies on anonymous donation and signed contracts with their patients on a case by case basis. The legal status in my country was further cemented with the long overdue adoption in 2015 of Act on Fertility Treatment that forbids non-anonymous donation and even excludes the prospective parents from the decision process on the choice of the donor. The burden of partially lost identity of my kids will be with me possibly my entire life. But I don’t want it to cast a shadow on our family relations. We have to deal with my non-genetic fatherhood one way or another. We maintain our family ties in full knowledge of the fact of the existence of some unnamed benefactor that made this possible. Maybe one day my children will find some unsuspected genetic relatives via increasingly popular public DNA banks if they choose so, thus sticking together parts of their identity. Only time will tell.

Background In light of the changing legislative and regulatory landscape concerning reproductive rights and fertility treatments worldwide and a growing number of patients who use assisted reproductive technology (ART)/in vitro fertilization (IVF) treatments to overcome their reproductive challenges (cancer patients, those needing genetic screening, members of the LGBTQIA+ community, and patients who have trouble conceiving naturally) and achieve their family-building goals, ART/IVF clinics face numerous operational and legal challenges, which come at great emotional, reputational, and financial costs to patients and providers. Objectives Fertility treatment related incidents and resulting legal cases vary in severity, scope, and outcomes. Local legal and regulatory environment for patients and ART/IVF providers increase the complexity. The authors aimed to identify the causes of lawsuits against ART/IVF providers and how legal outcomes varied between cases. Study design The data on U.S. IVF incidents was collected from Lexis Nexis, Westlaw, Bloomberg Law, and CaseLaw databases, newspaper and magazine articles, legal reviews, peer-reviewed journals, and online publications. For international cases, HFEA reports, and industry and online publications were queried. The searches were not time restrained but was carried out from January 2022 to April 2023. RESULTS Two hundred five IVF incidents (84.9% U.S., 2.9% U.K., 12.2% other), excluding large-scale tank and alarm failures and power disruptions, which affected 307 people (79.8%, 3.3%, 16.9%) and/or 258 specimens (84.5%, 2.7%, 12.8%), resulting in 76 lawsuits (65.8%, 7.89%, 26.3%) were identified worldwide, and categorized by error types. Specimen mix-ups were the most prevalent type (95.0%). Meanwhile, ten failed storage and alarm incidents caused most damage, affecting >1800 patients and >8100 specimens, and resulting in 181 initial lawsuits. CONCLUSIONS Overreliance on manual protocols, irregular/skipped audits, and human error were responsible for IVF incidents reviewed. Damaged, destroyed, or lost embryos and embryo transfer to the wrong recipient have lifelong devastating effects on patients, for many of whom IVF was their last chance for parenthood due to cancer treatment, infertility, and/or age. To complicate the cases, embryo mix-ups resulted in custody disputes over the newborn child(ren), as in Manukyan v. CHA Health Systems, and loss of identity in children and parents. U.S. babies born to embryo mix-ups are reunited with their genetic parents, following the legal precedent of Perry-Rogers v. Fasano. Many countries, however, grant the custody of the child(ren) to birth parents. Most lawsuits were dismissed or settled. The combination of changing abortion and personhood laws in several states of the US can further complicate the issue, as they might put patients and providers in legal jeopardy, following routine ART/IVF procedures. This may include preimplantation genetic testing, short- and long-term embryo storage, and embryo disposal. These state laws will limit patient options and restrict ART/IVF clinic operations. Owing to all these factors, in this study, we can only make educated estimates about the true scope of the issue and its financial cost to ART/IVF providers, which might range from thousands to millions of USD. Lawsuits also come at a great reputational cost for patients, their families and providers, so the latter might benefit from embracing digitization of records, automation, robotics, and AI as a standard of care in their practice.

Photo by Sangharsh Lohakare on Unsplash ABSTRACT The public should debate the ethical and social challenges arising from heritable human genome editing (HHGE). The notorious case involving He Jiankui may have led to the disfavor of gene editing and a precautionary approach. While the de facto global moratorium on HHGE is clearly justified considering our current inability to implement it safely and effectively, the difficult ethical considerations should be addressed prior to the ability to initiate widespread HHGE. This piece argues that prospective patients and other members of society beyond the scientific community must be included in the conversation. It emphasizes the potential role of those not directly participating in HHGE science, calling the broader academic community not simply to wait for scientists’ results and only afterward react. Pointing to key historical examples, I contend that scientific progress is intrinsically linked with the surrounding societal discussion and that it is not only scientists who can influence where the HHGE story ends. INTRODUCTION l. Rogue Scientists Chinese biophysicist He Jiankui announced the world’s first genetically modified babies in 2018. Naturally, the treatment aroused the attention of the world’s media, which focused on He’s reckless actions. Indeed, in setting up and carrying out the procedure in question, he flouted norms of good scientific practice on a range of levels—errors paid with time in prison. Since the He controversy, few scientists have aggressively approached heritable human genome editing (HHGE) and challenged the current research norms. The most outspoken exception is the Russian molecular biologist Denis Rebrikov of the Pirogov Russian National Research Medical University. He publicly declared his intention to apply clustered regularly interspaced short palindromic repeats (CRISPR) to embryos to help couples avoid passing serious medical conditions to their children. However, Rebrikov met fierce opposition both inside and beyond Russia and, with leading CRISPR scientists and bioethicists abroad describing him as a “cowboy” who had “weak data” and was trying to “grab some attention.”[1] So far, Rebrikov’s plans have failed to come to fruition. Although there are 126 entries listed in a registry of HHGE research recently created by the World Health Organization (WHO),[2],[3] it seems that clinical HHGE has been paused for the time being. ll. Steering the Conversation A section of the scientific community has been trying to steer the ethical debate on HHGE away from the actions of rogue scientists and back to an issue that is central to the matter—the interests of patients. The majority would agree that the most compelling potential application of germline genome editing is for the prevention of devastating genetic conditions, for example, when both parents carry Huntington’s disease, for which “genome editing offers the only prospect of bearing a healthy, genetically related child.”[4] Despite such justification for scientists to continue pursuing research in the area, there has been a notable reticence in the wider academic community regarding making the ethical case for HHGE and clarifying in which medical situations such a technique might be reasonably applied. Even among those who recognize that the HHGE cases' controversies should not be a reason for panic over designer babies, some believe that starting the ethical debate is premature. A key part of the argument is that the current technological and scientific knowledge available is far from ready to deliver on treatments. A similar stance preventing debate in the wider society is that “difficult questions” about cost, accessibility, and social justice remain.[5] Whether intended or not, the implication is that the position of wider society in the HHGE story should be a reactive one, namely waiting to see what the scientists throw at them and then dealing with it. I argue that there is not only an immediate need for broader academic and societal input on the ethical and social aspects of the HHGE debate but that there is a deep symbiosis between scientific progress and its surroundings, whereby science both shapes and is shaped by the societal environment in which it takes place. The WHO published a position paper, recommendations, and a framework for governance. The framework for governance describes global standards for the governance and oversight of HHGE.[6] The position paper emphasized the importance of global and inclusive dialogue,[7] and many other boards have also called for broad public engagement.[8] It is imperative that WHO’s governance framework meets everyone’s needs. After all, as with any medical treatment, it is not the scientist who developed the treatment or the doctor who delivers it that is most important– that honor falls to the patient. In the case of HHGE, the beneficiaries include those members of society who hope to reproduce. Yet HHGE has the potential to impact society. We all should have an opportunity to be a part of world-changing decisions that lead to the creation are made and feel a responsibility to participate. lll. Shutting Down the Academic Debate At the 30th Annual Conference of the Japanese Association for Bioethics, which took place in late 2018 after He’s experiment, the discussion about HHGE was shut down quickly. Notwithstanding the understandable issues raised with He’s case, one participant after another stood up to voice support for an outright and complete ban on the use of CRISPR.[9] The ban was based on the grounds that editing the human genome would result in a cascade of unforeseen and irreversible consequences for future generations. One participant forcefully argued that “the deoxyribose nucleic acid (DNA) rubicon should never be crossed for above all, it was deeply immoral to do so when there was no way of obtaining the consent of those who would actually stand affected—our descendants.”[10] Another saw it as putting humanity on a slippery slope toward enhancements, and some feared the catastrophic mistakes that might result from their use.[11] While the above event provides just one snapshot of the debate that was taking place around the world at the time, it captures the strong reservations in the scientific community. It is a common view, not only in Japan, that the human genome is something sacred, a relic handed down from generations, that we ought to treasure and preserve. In support of such a view, religious and other more pragmatic reasons are offered. For example, some may fear the disasters that might befall us if we choose to intervene in the process through which we pass our genetic code from one generation to another. Such arguments are certainly still at the heart of the ethical debate, but the foundations upon which they are built are by no means universally accepted. Stanford University bioethicist Henry Greely writes, “the human germline genome” does not exist; instead, each of us has a unique genome.[12] Greely argues that HHGE is no different from the changes our genomes have undergone through numerous medical interventions. For example, synthetic insulin has increased the number of people with DNA variations that lead to diabetes. Those with this condition would have died as a child in the past. However, now they live long enough to be able to reproduce. Similarly, the transition from hunting to farming centuries ago resulted in a greater number of copies in our gene pool of starch-digesting genes. Yet Greely suggested that, practically, HHGE is “not very useful in the near- to midterm” (by which he means “the next several decades”)[13] “mainly because other technologies can attain almost all the important hoped-for benefits of [HHGE], often with lower risk,” citing embryo selection and somatic gene editing as two alternative options. Greely argued that applying HHGE for enhancement beyond disease prevention and is currently not a realistic option because we lack the necessary knowledge. In Greely’s opinion, “how worried should we be [about HHGE]…? A bit, but not very and not about much.”[14] Greely’s assertions that other scientific debates should take precedence and that the concerns are not ripe for debate yet are concerning. lV. Why Shutting Down the Debate Might Not be a Good Idea First, the timeframe described by Greely seems somewhat out of line with that described by leading scientists. As far back as 2018, at the same Summit where He made his revelations, George Q. Daley stressed that HHGE is scientifically feasible here and that the ethical considerations can no longer be put off: “…a number of groups have applied gene editing now to human embryos in the context of in vitro fertilization and attempting to determine variations of a protocol that would enhance the fidelity and reduce mosaicism. I think there has been an emerging consensus that the off-target problem is manageable, and in some cases even infinitesimal. There are some interesting proofs of principles, like diseases such as beta-thalassemia that could potentially be approached with this strategy.”[15] It would also be possible to challenge Greely on various other aspects. One of which would be the number of cases to which HHGE would be relevant and the kinds of moral allowances that might be made, and each case concludes that more urgency is required in the ethical debate. Greely suggests that most people can use preimplantation genetic testing (PGD), which is the embryo selection process, and that perhaps HHGE could apply to couples where both have the same autosomal recessive gene.[16] Greely rules out considering HHGE in cases where PGD is applicable. Greely concedes PGD does not already represent the answer on this topic, as it often fails to provide couples with enough healthy embryos to transfer. As a resolution to this issue, he points to the creation of eggs using induced pluripotent stem cell (iPSC) techniques, whereby eggs can potentially be created from other cells.[17] However, given the extremely limited success of iPSCs in the clinical arena to date, in vitro gametogenesis is a highly speculative solution. Certainly, the progress of iPSC research is not such a safe bet that placing all our hopes on it at the expense of HHGE techniques is currently justified. (Also, it should be noted that making eggs using the iPSC technique is hardly an ethical problem-free area itself.) In summary, the cases of couples looking to conceive that Greely rules out by pointing to PGD should be kept on the HHGE table, as various other scholars have suggested.[18] Many of us debating HHGE are not scientists, so the best we can do is draw from the information we glean from those more technically capable. As a society, we are not just passive observers of science; we should have influence over decisions that impact society. Indeed, even if the available science is not yet at a place where we should be worried about large-scale ethical and social concerns, the story will continue to unfold in the future. While Greely is happy to see the human race “muddle through” the ethical challenges of scientific breakthroughs, such a position fails to recognize that society at large is far from powerless. V. Society Influencing Scientific Progress There are some notable examples of society’s impact on scientific progress. For example, political policies led to the development of nuclear technology for war and strategic deterrence, despite societal objections seen through demonstrations of people protesting using the slogan “no nukes.” Furthermore, the Bush administration drastically limited the use of embryonic stem cells in the 2000s due to a strong religious and cultural influence on policy.[19] Societal debate potentially serves as a powerful factor in guiding science. Where societal acceptance is ambiguous, science tends to operate on its own. But where science would impact life’s fundamental issues like war, how embryos should be valued, or the end of life, society should weigh in and influence the role of science. Societal views on the current global moratorium on HHGE could lead to a ban, as has been advocated.[20] On the other hand, societal views that value HHGE as a way to expand reproductive autonomy may justify permitting its use. Opening an ethics debate about it would enable scientists to pursue technologies that society deems justifiable as well as set limits for where they should stop. Making this process more difficult, the He affair has clearly colored public discourse on HHGE in a way that inhibits debate. In Japan, a sequence of questionnaires in 2016, 2018, and 2019 showed that the widely publicized HHGE scandal led to a significant decline in the acceptance of genome editing technology in general, particularly for human reproduction. Specifically, the surveys revealed a stark rise in disapproval of the technology’s use on fertilized human eggs—from 12 percent in 2018 to 29 percent in 2019.[21] The three scientists that conducted these surveys suggested that “the news of the twin babies in China had a substantial influence on the Japanese public,” damaging the reputation of HHGE.[22] It seems likely that the public distaste for HHGE was prompted by He’s research rather than considerations about the scientific potential of HHGE The change in public opinion may also make politicians and scientists more hesitant when it comes to taking the lead in the HHGE debate. Ultimately, this can restrict the public discussion of the central ethical challenges of the technology and hinder efforts to determine whether there is a responsible path forward other than an outright ban. Stressing the importance of the issue again to potential patients and failing to engage further with the HHGE debate is surely not something society should allow. While there are many important ongoing debates about genetics, like biohacking and DIY hobbyists, HHGE deserves attention as well. In fact, attention to the ethics of HHGE should help — more awareness of how these tools can be applied and what germline genome editing is will make people more alert to the existing danger and better understand how to mitigate it. Perhaps more importantly, a clear message from society to researchers about what objectives are reasonable to pursue regarding the HHGE technologies will facilitate good science. Having a publicly determined criterion would allow scientists to not live in fear that they might be blacklisted for seeking progress in grey areas and instead confidently chase progress where it is allowed. Vl. What Now? HHGE is here (or will be soon) and brings many ethical and social challenges. However, the challenges should not be left to individual scientists and couples in desperate situations to manage alone. Moving toward how these challenges can be met practically, it is helpful to draw a parallel with the issue of implementing human rights. In the early 21st century, political philosopher Michael Freeman of the University of Essex lamented that implementing human rights had been left to lawyers. Although legal experts were clearly essential in putting together the global human rights framework, Freeman’s concern was that they were not best placed to understand implementing human rights in various contexts. Setting out a broader, interdisciplinary approach, he called for social scientists to tackle these difficult questions, ultimately moving human rights forward around the world. Similarly, in medical technology like HHGE, scientists are crucial to the story, but at the same time, they are not trained to deal with all the accompanying challenges. Bioethicists are also important, clarifying the arguments that society needs to resolve. There is a need for even wider input from across the scholarly community. For instance, as with human rights, international and domestic regulation is required, and clearly, the legal community has a role here. Moreover, as described by Freeman, since all law is political in its creation and has impacts across society, political scientists and sociologists can provide impactful input. CONCLUSION We are in it together, and we have roles to play in the discussion of HHGE. Societal discourse does not always trail the scientific reality, but rather, it can condition the path that science will follow. Given the importance of what is at stake, not only for the potential patients, but for humanity, we should not leave the HHGE debate only to scientists, and we should not leave it until later. - [1] Cohen J. “Embattled Russian scientist sharpens plans to create gene-edited babies,” Science, 21 Oct. 2019. doi:10.1126/science.aaz9337. [2] World Health Organization. “WHO issues new recommendations on human genome editing for the advancement of public health,” News release, 12 July 2021, www.who.int/news/item/12-07-2021-who-issues-new-recommendations-on-human-genome-editing-for-the-advancement-of-public-health. [3] World Health Organization. “Human Genome Editing Registry,” https://www.who.int/groups/expert-advisory-committee-on-developing-global-standards-for-governance-and-oversight-of-human-genome-editing/registry. [4] Daley GQ, Lovell-Badge R, and Steffann J. “After the Storm–A Responsible Path for Genome Editing,” New England Journal of Medicine 380, no. 10 (2019): 897-9. doi:10.1056/NEJMp1900504. [5] Daley GQ, Lovell-Badge R, and Steffann J. “After the Storm–A Responsible Path for Genome Editing,” New England Journal of Medicine 380, no. 10 (2019): 897-9. doi:10.1056/NEJMp1900504 [6] World Health Organization. “WHO issues new recommendations on human genome editing for the advancement of public health,” News Release, July 12, 2021, www.who.int/news/item/12-07-2021-who-issues-new-recommendations-on-human-genome-editing-for-the-advancement-of-public-health. [7] WHO 2021. Human Genome Editing: Position Paper, WHO Expert Advisory Committee on Developing Global Standards for Governance and Oversight of Human Genome Editing. [8] Daley GQ, Lovell-Badge R, and Steffann J. “After the Storm–A Responsible Path for Genome Editing,” New England Journal of Medicine 380, no. 10 (2019): 897-9. doi:10.1056/NEJMp1900504. [9] 30th Annual Conference of the Japanese Association for Bioethics, 8-9 Dec. 2018, Kyoto Prefectural University, Kyoto. [10] 30th Annual Conference of the Japanese Association for Bioethics, 8-9 Dec. 2018, Kyoto Prefectural University, Kyoto. [11] 30th Annual Conference of the Japanese Association for Bioethics, 8-9 Dec. 2018, Kyoto Prefectural University, Kyoto. [12] Greely HT. “Why the Panic Over ‘Designer Babies’ Is the Wrong Worry,” LeapsMag, 30 Oct. 2017, leapsmag.com/much-ado-about-nothing-much-crispr-for-human-embryo-editing; Greely HT. “CRISPR’d babies: human germline genome editing in the ‘He Jiankui Affair’,” Journal of Law and the Biosciences 2019; 6(1): 111–83. doi: 10.1093/jlb/lsz010; Greely HT. CRISPR People: The Science and Ethics of Editing Humans (Massachusetts: Massachusetts Institute of Technology Press, 2021). [13] Greely HT. “Why the Panic Over ‘Designer Babies’ Is the Wrong Worry,” LeapsMag, 30 Oct. 2017, leapsmag.com/much-ado-about-nothing-much-crispr-for-human-embryo-editing. [14] Greely HT. “Why the Panic Over ‘Designer Babies’ Is the Wrong Worry,” LeapsMag, 30 Oct. 2017, leapsmag.com/much-ado-about-nothing-much-crispr-for-human-embryo-editing. [15] Daley, G. (n.d.). Genome-editing-pathways to Translation. Transcript of the Human-Genome Editing Summit 2018 Hong Kong. Retrieved March 17, 2022, from https://diyhpl.us/wiki/transcripts/human-genome-editing-summit/2018-hong-kong/george-daley-genome-editing-pathways-to-translation/ [16] Greely HT. “CRISPR’d babies: human germline genome editing in the ‘He Jiankui affair’,” Journal of Law and the Biosciences 2019: 6(1): 111–83. doi:10.1093/jlb/lsz010. [17] Greely HT. CRISPR People: The Science and Ethics of Editing Humans (Massachusetts: Massachusetts Institute of Technology Press, 2021). [18] Rasnich R. “Germline genome editing versus preimplantation genetic diagnosis: Is there a case in favour of germline interventions?.” Bioethics 2020; 34(1): 60–9. [19] Murugan, Varnee. “Embryonic stem cell research: a decade of debate from Bush to Obama.” The Yale journal of biology and medicine vol. 82,3 (2009): 101-3. [20] Lander E, Baylis F, Zhang F, et al. “Adopt a moratorium on heritable genome editing,” Nature 2019; 567(7747): 165–8. pmid:30867611. [21] Watanabe D, Sato Y, Tsuda M, and Ohsawa R. Increased awareness and decreased acceptance of genome-editing technology: The impact of the Chinese twin babies. PLoS ONE 2000; 15(1): 1-13. doi:10.1371/journal.pone.0238128. [22] Watanabe D, Sato Y, Tsuda M, and Ohsawa R. Increased awareness and decreased acceptance of genome-editing technology: The impact of the Chinese twin babies. PLoS ONE 2000; 15(1): 1-13. doi:10.1371/journal.pone.0238128.

Photo by Filip Mroz on Unsplash INTRODUCTION The first live births via uterine transplant using deceased donors (UTx) occurred in Brazil in 2017[1] and in the United States in 2019.[2] Prior to that, living donors were the source of uteruses for transplant, with the first successful birth in Sweden in 2014, and the first successful birth in the US in 2017. This achievement in reproductive technology gives women with absolute uterine factor infertility (AUFI) the option to become a biological parent. In the US, 120,000 women of childbearing age are affected by AUFI.[3] Without UTx, their only option for having genetically related children is through gestational surrogacy. Since some religions and cultures prohibit the use of surrogates to achieve motherhood and surrogacy is illegal in many countries, some women would not otherwise have the chance to have biological children. For instance, China, Finland, Germany, Iceland, and other countries prohibit any form of commercial or altruistic surrogacy making adoption the only option for becoming a mother. However, in many cultures, biological ties are central to the understanding of the family. For example, in the Middle East, adoption is uncommon because biological connections are crucial.[4] Therefore, the only option these women would choose to become a mother is UTx. The exclusive value of UTx to these women is being able to experience pregnancy. Thus, UTx gives unique benefits to these women that adoption or surrogacy would not. The procedure entails surgery on a living or deceased donor to acquire the uterus. Then, the recipient undergoes transplantation followed by a course of immunosuppressive medication. After in vitro fertilization (IVF), the embryo is implanted into the transplanted uterus. If the pregnancy progresses, the child is delivered by C-section and the uterus is removed either simultaneously or later. This paper argues that both deceased and living donors should be permitted, while increased-risk donors should not be eligible. ANALYSIS l. Permitting Living Donors or Limiting all UTx to Deceased Donors The ethics of using a uterus from a deceased donor differs from using one from a living donor. The biggest concern for living donation is that it exposes the donor to unacceptable risks, especially considering that the procedure is elective and not life-saving. In other types of transplants, the sacrifice is warranted because the organ is needed to save the recipient's life. For instance, living kidney donations protect against kidney failure.[5] The uterine donor undergoes a four to eight-hour surgery to acquire the uterus for no potential health benefit to themselves or arguably, to the recipient.[6] UTx is not a life-saving procedure. Some argue that because there is no imminent threat to the health of patients with AUFI, it is unnecessary to expose live donors to risks of UTx. While treating AUFI is not technically medically necessary, many women find infertility debilitating to their physical and mental health. As a result, women want their infertility treated. Now that UTx with deceased donors has been successful, the ethical justification for continuing to allow living donation could be questioned. UTx from deceased donors cannot harm the donor and thus has a different overall risk-benefit calculation. It is reasonable to believe that opponents of living donation may view UTx from deceased donors as ethically permissible. From the public health and ethical perspective, retrieving uteruses from deceased donors is a preferable option for the following reasons: First, there is no medical risk to the donor; thus, public resources do not need to be allocated to resolving the potential complications from the procedure. Additionally, acquiring a uterus from a deceased donor takes less time than from a living donor.[7] Using deceased donors also decreases operating room visits compared to living-donor uterus acquisition, and allocates more time for the operating room to perform other procedures. However, without living donors, the pool of available uteruses for transplantation narrows. In 2017, there were 2,200 deceased female donors aged 18-47 in the US, defined as those willing to donate, not those with a procurable and usable uterus, or even a uterus at all.[8] 2,200 is an extremely low number of potential uterus donors considering that there are more than 120,000 women with AUFI in the US. Not every available uterus is suitable for donation; each must pass quality control. These donors could have had a hysterectomy, no pregnancies (having had a pregnancy makes the uterus more suitable for transplant), papillomavirus infection, or other conditions that would prevent them from being uterus donors.[9] Therefore, the number of potentially suitable uteruses from deceased donors is probably lower than 2,200. There is significant uterus scarcity. To expand the donor pool, living-donor transplants should be allowed to continue. Using living donors respects individual autonomy. The uterus does not serve a vital purpose and women who have had successful pregnancies and do not want to become pregnant again can donate without a concern for their own fertility. Because most living donors are related to the recipients, they will also benefit from this procedure since it would enable them to have family relationships, perhaps becoming an aunt or grandparent. By decreasing wait time, allowing living donors also would provide the option of UTx while women are younger and more likely to achieve pregnancy since the IVF would be more likely to succeed increasing the chances that UTx would result in a child. ll. Increased-Risk Donors To further expand the pool of donors, some favor making organs from “increased-risk” donors available to recipients. Increased-risk donors range from those with a history of IV drug use or certain sexual or behavioral histories.[10] The main risk associated with transplantation from increased-risk donors is the possibility of transmission of infections like HIV, hepatitis B, or hepatitis C. Whether the scarcity of transplantable uteruses makes it ethical to include increased-risk donors in the UTx donor pool, assuming there is still a scarcity once other qualified living donors are permitted depends on the risks and benefits. The organs of increased-risk donors are offered to patients for life-saving procedures such as a liver transplant.[11] For example, since the donor pool in South Africa is small, in one case, the best option was for a child to receive a partial liver transplant from his HIV-positive mother. The donation was approved to save the life. The risk of HIV infection, and the need for lifetime antiretroviral therapy paled in comparison to death due to the unavailability of a deceased or low-risk liver donor.[12] Yet, UTx is not a life-saving procedure. Because infertility treatment is not lifesaving, the risks do not outweigh the benefits. Increased-risk donations use the organs that otherwise may have been disposed of (or rejected by potential recipients) categorically even if a donor did not actually have the underlying disease like HIV, hepatitis B, or hepatitis C.[13] Yet increased-risk donations pose ethically unacceptable risks to the recipient and their fetus in the case of UTx. If the patient remained on the waitlist for a uterus transplant, she and the resulting fetus would forgo the risks associated with using an increased-risk donor. It is possible that being on a waitlist could be psychologically traumatizing for a patient. This does not justify the potential to expose the woman and possibly a fetus to HIV, or hepatitis B or hepatitis C if an increased-risk donor provided a uterus and had an undetected condition While infertility may be devastating to the women wanting UTx, UTx should not be treated as a life-saving procedure. Therefore, it is unethical to expand the donor pool to include increased-risk donors. lll. Potential Downsides of the Availability of Uterine Transplant The availability of UTx to the public may impose additional pressure on women affected by infertility to try an additional burdensome procedure before giving up genetic motherhood. In cultures where family ties are important, the spouse or family members may pressure women to undergo UTx for the benefit of having biological children. Moreover, it may add overall pressure on the women to become mothers and exacerbate the deficiency stigma on infertile women. Moreover, the availability of UTx may compromise the future of many children who are waiting for adoption. Adoption may start to be seen by others only as a last resort after attempting to have biological children. This is problematic because there are many already existing children who need parental love. These downsides can be addressed by assurances that women freely enter UTx. Counseling and assurances that women are acting of their own accord and not under duress or societal pressure can mitigate the downsides. The autonomy and the choice to engage in new assisted reproduction should not be dismissed out of a fear that women are choosing UTx for the wrong reasons. CONCLUSION UTx offers women with AUFI unique benefits like the experience of pregnancy and having children genetically related to them. A woman deciding whether to receive a uterus from a living or deceased donor, or not to undergo UTx at all should understand the risks and benefits, including the risk of the UTx not resulting in a viable pregnancy. Doctors or hospitals should decide whether to perform UTx on a case-by-case basis. Increased-risk donation that could expose the recipient and fetus to transmissible disease should be prohibited because the risks associated with increased-risk donation are not morally justified by UTx. Remaining on the transplant list would be safer. While increased-risk UTx should be prohibited, other living-donor procedures should be continued to widen the donor pool. Living-donor UTx will empower the donor since she will voluntarily make the decision to donate, helping another person. Women with infertility whose only chance to have a biological child should not be limited to uteruses supplied by deceased donors. [1] France 24, “First Baby Born after Uterus Transplant in France,” France 24 (France 24, February 17, 2021), https://www.france24.com/en/live-news/20210217-first-baby-born-after-uterus-transplant-in-france. [2] “For the First Time in North America, a Woman Gives Birth After Uterus Transplant From a Deceased Donor,” Health Essentials from Cleveland Clinic (Health Essentials from Cleveland Clinic, July 9, 2019), https://health.clevelandclinic.org/for-the-first-time-in-north-america-woman-gives-birth-after-uterus-transplant-from-deceased-donor/. [3] Max M. Maurer et al., “First Healthy Baby After Deceased Donor Uterus Transplantation: Birth to a New Era?” Transplantation 103, no. 4 (2019): pp. 652-653, https://doi.org/10.1097/tp.0000000000002627. [4] Yassari, N. “Adding by Choice: Adoption and Functional Equivalents in Islamic and Middle Eastern Law.” The American Journal of Comparative Law, 63(4), 927-962. Retrieved April 22, 2021, from https://www.jstor.org/stable/26425445 (Acknowledges that traditional Islamic law prohibits adoption but arguing jurisdictions have worked around the prohibition to create avenues toward adoption.) [5] Though some people might argue that dialysis would be an option, generally kidney transplants are justified by medical necessity and a transplant both saves the life and significantly improves quality of life compared to dialysis. [6] “Uterus Transplants: A New Door Opens,” Penn Medicine, April 29, 2019, https://www.pennmedicine.org/news/internal-newsletters/system-news/2019/may19/uterus-transplants-a-new-door-opens. [7] Niclas Kvarnström et al., “Live versus Deceased Donor in Uterus Transplantation,” Fertility and Sterility 112, no. 1 (2019): pp. 24-27, https://doi.org/10.1016/j.fertnstert.2019.05.029, 25. [8] Max M. Maurer et al., “First Healthy Baby After Deceased Donor Uterus Transplantation: Birth to a New Era?” Transplantation 103, no. 4 (2019): pp. 652-653, https://doi.org/10.1097/tp.0000000000002627, 653. [9] Max M. Maurer et al., “First Healthy Baby After Deceased Donor Uterus Transplantation: Birth to a New Era?” Transplantation 103, no. 4 (2019): pp. 652-653, https://doi.org/10.1097/tp.0000000000002627, 653. [10] Shelly Bansal et al., “Risky Business: Taking the Stigma Out of High-Risk Donation in Lung Transplantation,” The Annals of Thoracic Surgery 100, no. 5 (2015): pp. 1787-1794, https://doi.org/10.1016/j.athoracsur.2015.05.065, 1787. The Centers for Disease Control (CDC) define the high-risk donor if a person meets one or more of the following criteria: “1) men who have had sex with other men in the last 5 years, 2) a history of intravenous drug abuse, 3) persons who have hemophilia, 4) persons who have engaged in sex for money or drugs in the past 5 years, 5) persons who have engaged in sex with individuals who have high-risk behaviors or those that are suspected to have HIV, 6) anyone who has been exposed to HIV in the last 12 months, 7) inmates, and 8) children born to mothers who had HIV or mothers who met the criteria for high risk. [11] Jean Botha et al., “HIV and Solid Organ Transplantation: Where Are We Now,” Current HIV/AIDS Reports 16, no. 5 (April 2019): pp. 404-413, https://doi.org/10.1007/s11904-019-00460-7, 404. Harriet Rosanne Etheredge et al., “Needs Must: Living Donor Liver Transplantation from an HIV-Positive Mother to Her HIV-Negative Child in Johannesburg, South Africa,” Journal of Medical Ethics 45, no. 5 (2019): pp. 287-290, https://doi.org/10.1136/medethics-2018-105216. (A partial liver transplant was done from an HIV-positive mother to an HIV-negative child in South Africa in 2017). [12] Botha, et al. [13] David S. Goldberg and Josh Levitsky, “Transplanting Livers from HCV ‐Infected Donors into HCV ‐Negative Recipients: Promise but Mind the Pitfalls,” American Journal of Transplantation 19, no. 5 (December 2018): pp. 1264-1265, https://doi.org/10.1111/ajt.15193, 1264.

Photo by Christian Bowen on Unsplash ABSTRACT Assisted Reproductive Technology can be a beneficial tool for couples unable to reproduce independently; however, it has historically discriminated against the LGBTQ+ community members. Given the evolution and acceptance of LGBTQ rights in recent years, discrimination and barriers to access reproductive technology and health care should be readdressed as they still exist within this community. INTRODUCTION In recent years, the LGBTQ+ community has made great strides toward attaining equal rights. This fight dates back to 1970 when Michael Baker and McConnell applied for a marriage license in Minnesota.[1] After the county courthouse denied the couple's request, they appealed to the Minnesota Supreme Court. Baker and McConnell’s dispute reached the US Supreme Court. Baker v. Nelson[2] was the first time a same-sex couple attempted to pursue marriage through higher courts in the US.[3] Because the couple lost the case, Baker changed his name to a gender-neutral one, and McConnell adopted Baker, allowing Baker and McConnell to have legal protections like the ability to receive certain inheritances. Baker and McConnell received a marriage license from an unsuspecting clerk from Blue Earth County, where they wed on September 3, 1971.[4] BACKGROUND The Supreme Court’s decision left individual state legislatures the option to accommodate same-sex couples’ rights constitutionally. As a result, some states banned same-sex marriage, while others offered alternative options such as domestic partnerships. With many obstacles, such as the Defense of Marriage Act (DOMA) and President Bush’s efforts to limit marriage to heterosexual people, Massachusetts became the first state to legalize gay marriage in 2003.[5] Other states slowly followed. Finally, in 2015 the US Supreme Court made same-sex marriage legal in all 50 states in Obergefell v. Hodges,[6] marking an important milestone for the LGBTQ+ community’s fight toward marriage equality. The Obergefell v. Hodges decision emphasized that members of the homosexual community are “not to be condemned to live in loneliness, excluded from one of civilization's oldest institutions,” thus granting them the right to “equal dignity in the eyes of the law.”[7] This paper argues that in the aftermath of the wide acceptance of LGBTQ rights, discrimination and barriers to access reproductive technology and health care persist nationally. Procreation also faces discrimination. Research supports that children’s overall psychological and physical welfare with same-sex parents does not differ compared to children with heterosexual parents.[8] Some others worry about the children’s developmental health and argue that same-sex male couples’ inability to breastfeed their children may be harmful; however, such parents can obtain breast milk via surrogate donation.[9] Further concerns regarding confusion in gender identity in children raised by same-sex parents are not supported by research in the field indicating that there are “no negative developmental or psychological outcomes for a child, nor does it result in differing gender identity, gender role behavior or sexual partner preference compared to opposite-sex parents.”[10] ANALYSIS l. Desire to Procreate The American perception toward same-sex unions has evolved “from pathology to deviant lifestyle to identity.”[11] In 2001, only 35 percent of Americans favored same‐sex marriage, while 62 percent favored it in 2017.[12] The “Gay marriage generation”[13] has a positive attitude toward same-sex unions, arising from the “interaction among activists, celebrities, political and religious leaders, and ordinary people, who together reconfigured Americans’ social imagination of homosexuality in a way that made gay marriage seem normal, logical, and good.”[14] Same-sex couples’ right to build a biological family and ability to do so using modern reproductive technology is unclear. The data generated by the LGBTQ Family Building Survey revealed “dramatic differences in expectations around family building between LGBTQ millennials (aged 18-35) and older generations of LGBTQ people,”[15] which may be in part attributable to recent federal rulings in favor of same-sex couples. Three important results from this survey are that 63 percent of LGBTQ millennials are considering expanding their families throughout parenthood, 48 percent of LGBTQ millennials are actively planning to grow their families, compared to 55 percent of non-LGBTQ millennials; and 63 percent of those LGBTQ people interested in building a family expect to use assisted reproductive technology (ART), foster care, or adoption to become parents.[16] There are 15.9 million Americans who identify as LGBTQ+ (6.1 million of whom are 18 to 35 years old); thus, an estimated “3.8 million LGBTQ+ millennials are considering expanding their families in the coming years, and 2.9 million are actively planning to do so.”[17] Yet access and affordability to ART, especially in vitro fertilization (IVF) and surrogacy for same-sex couples, has not been consistent at a national level. The two primary problems accessing ART for the LGBTQ community are the lack of federal law and cost. A federal law that guaranteed coverage would address both problems. ll. ART for Same-Sex Couples All same-sex male (SSM) couples and same-sex female (SSF) couples must involve third parties, including surrogates or egg or sperm donors.[18] ART involves the legal status of “up to two women (surrogate and egg donor),” the intended parents, and the child for SSM couples.[19] While sometimes necessary for heterosexual couples using ART, an egg or sperm from someone other than the intended parents or a surrogate will always be necessary for the LGBTQ people seeking ART. ART, in particular IVF, is essential for infertile couples unable to conceive on their own. Unlike other industrialized countries (such as Canada, the United Kingdom, Sweden, Germany, and Australia), the US does not heavily oversee this multibillion-dollar industry.[20] The American Society for Reproductive Medicine does provide lengthy guidelines to fertility clinics and sperm banks; however, state lawmakers have been less active as they seem to avoid the controversy surrounding controversial topics like embryo creation and abortion.[21] As a result, states “do not regulate how many children may be conceived from one donor, what types of medical information or updates must be supplied by donors, what genetic tests may be performed on embryos, how many fertilized eggs may be placed in a woman or how old a donor can be.”[22] lll. A Flawed Definition of Infertility The WHO defines the medical definition of infertility as “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after twelve months or more of regular unprotected sexual intercourse.”[23] This antiquated definition must be updated to include social infertility to integrate same-sex couples’ rights.[24] In the US, single individuals and LGBTQ couples interested in building a family by biological means are considered “socially infertile.”[25] If insurance coverage is allotted only to those with physical infertility, then it is exclusive to the heterosexual community. Although some states, such as New York, discussed below, have directly addressed this inequality by extending the definition of infertility and coverage of infertility treatments to include all residents regardless of sexual orientation, this is not yet the norm everywhere else. The outdated definition of infertility is one of the main issues affecting same-sex couples’ access to ART, as medical insurance companies hold on to the formal definition of infertility to deny coverage. lV. Insurance Coverage for IVF Insurance coverage varies per state and relies on the flawed definition of infertility. As of August 2020, 19 states have passed laws requiring insurance coverage for infertility, 13 of which include IVF coverage, as seen in Figure 1. Also, most states do not offer IVF coverage to low-income people through Medicaid.[26] In states that mandate IVF insurance coverage, the utilization rate was “277% of the rate when there was no coverage,”[27] which supports the likelihood that in other states, the cost is a primary barrier to access. When insurance does not cover ART, ART is reserved for wealthy individuals. One cycle of ART could cost, on average, “between $10,000 and $15,000.”[28] In addition, multiple cycles are often required as one IVF cycle only has “about a 25% to 30%” live birth success rate.[29] Altogether, the total cost of successful childbirth was estimated from $44,000 to $211,940 in 1992.[30] On February 11, 2021, New York Governor Andrew M. Cuomo “directed the Department of Financial Services to ensure that insurers begin covering fertility services immediately for same-sex couples who wish to start a family.”[31] New York had recently passed an IVF insurance law that required “large group insurance policies and contracts that provide medical, major medical, or similar comprehensive-type coverage and are delivered or issued for delivery in New York to cover three cycles of IVF used in the treatment of infertility.”[32] But the law fell short for same-sex couples, which were still required to “pay 6 or 12 months of out-of-pocket expenses for fertility treatments such as testing and therapeutic donor insemination procedures before qualifying for coverage.”[33] Cuomo’s subsequent order made up for gaps in the law, which defined infertility as “the inability to conceive after a certain period of unprotected intercourse or donor insemination.”[34] Cuomo’s order and the law combine to make New York an example other states can follow to broaden access to ART. V. Surrogacy Access to surrogacy also presents its own set of problems, although not exclusive to the LGBTQ community. Among states, there are differences in how and when parental rights are established. States in dark green in Figure 2 allow pre-birth orders, while the states in light green allow post-birth parentage orders. Pre-birth orders “are obtained prior to the child’s birth, and they order that the intended parent(s) will be recognized as the child’s only legal parent(s) and will be placed on the child’s birth certificate,” while post-birth parentage orders have the same intent but are obtained after the child’s birth. [35] For instance, states can require genetic testing post-birth, possibly causing a delay in establishing parentage.[36] Although preventable through the execution of a health care power of attorney, a surrogate mother could be the legal, medical decision-maker for the baby before the intended parents are legally recognized. On February 15, 2021, gestational surrogacy – the most popular type of surrogacy in which the surrogate has no biological link to the baby – was legalized in New York,[37] but it remains illegal in some states such as Nebraska, Louisiana, and Michigan.[38] In addition, the costs of surrogacy are rising, and it can cost $100,000 in the US.[39] Medicaid does not cover surrogacy costs,[40] and some health insurance policies provide supplemental surrogacy insurance with premiums of approximately $10,000 and deductibles starting at $15,000.[41] Thus, “surrogacy is really only available to those gay and lesbian couples who are upper class,”[42] leaving non-affluent couples out of options to start a family through biological means. Vl. A Right to Equality and Procreation Some argue that same-sex couples should have the right to procreate (or reproductive rights). Based on arguments stemming from equal rights and non-discrimination, same-sex couples who need to use ART to procreate should have access to it. The need to merge social infertility into the currently incomplete definition of fertility could help same-sex couples achieve access through insurance coverage. The human right of equality and non-discrimination guarantees “equal and effective protection against discrimination on any ground.”[43] The United Nations later clarified that “sexual orientation is a concept which is undoubtedly covered” [44] by this protection. The right to procreate is not overtly mentioned in the US Constitution; however, the Equal Protection Clause states that “No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States… without due process of law.”[45] In fact, some states have abridged the reproductive privileges of some US citizens by upholding prohibitive and intricate mechanisms that deter same-sex couples from enjoying the privileges other citizens have. The Supreme Court acknowledged procreation as a “fundamental”[46] personal right, in Skinner v. Oklahoma, mandating that the reproductive rights of individuals be upheld as the right to procreate is “one of the basic civil rights of man”[47] because “procreation [is] fundamental to the very existence and survival of the race.”[48] In Eisenstadt v. Baird, the courts also supported that “the decision whether to bear or beget a child” fundamentally affects a person.[49] I argue that this protection extends to same-sex couples seeking to procreate. Finally, Obergefell v. Hodges held that the Due Process and Equal Protection clauses ensure same-sex couples the right to marriage, as marriage “safeguards children and families, draw[ing] meaning from related rights of childrearing, procreation, and education.”[50] By implicit or explicit means, these cases align with the freedom to procreate that should not be unequally applied to different social or economic groups. Yet, the cases do not apply to accessing expensive tools to procreate. As heterosexuals and the LGBTQ community face trouble accessing expensive ART for vastly different reasons, especially IVF and surrogacy, the equal rights or discrimination argument is not as helpful. For now, it is relevant to adoption cases where religious groups can discriminate.[51] The insurance coverage level may be the best approach. While the social norms adapt and become more inclusive, the elimination of the infertility requirement or changing the definition of infertility could work. Several arguments could address the insurance coverage deficit. Under one argument, a biological or physical inability to conceive exists in the homosexual couple trying to achieve a pregnancy. Depending on the wording or a social definition, a caselaw could be developed arguing the medical definition of infertility applies to the LGBTQ community as those trying to procreate are physically unable to conceive as a couple planning to become parents. One counterargument to that approach is that it can be offensive to label people infertile (or disabled) only because of their status as part of a homosexual couple.[52] CONCLUSION In the last 50 years, there has been a notable shift in the social acceptance of homosexuality.[53] Marriage equality has opened the door for further social and legal equality, as evidenced by the increased number of same-sex couples seeking parenthood “via co-parenting, fostering, adoption or surrogacy” – colloquially referred to as the ‘Gayby Boom’.[54] However, some prejudice and disdain toward LGBTQ+ parenting remain. Equitable access to ART for all people may be attainable as new technology drives costs down, legislators face societal pressure to require broader insurance coverage, and social norms become more inclusive. [1] Eckholm, E. (2015, May 17). The same-sex couple who got a marriage license in 1971. Retrieved April 08, 2021, from https://www.nytimes.com/2015/05/17/us/the-same-sex-couple-who-got-a-marriage-license-in-1971.html [2] Eckholm, E. [3] A brief history of civil rights in the United States: A timeline of the legalization of same-sex marriage in the U.S. (2021, January 27). Retrieved April 08, 2021, from https://guides.ll.georgetown.edu/c.php?g=592919&p=4182201 [4] Eckholm, E. [5] A brief history of civil rights in the United States: A timeline of the legalization of same-sex marriage in the U.S. (2021, January 27). Retrieved April 08, 2021, from https://guides.ll.georgetown.edu/c.php?g=592919&p=4182201 [6] A brief history of civil rights in the United States [7] A brief history of civil rights in the United States [8] Lee, J., & Bolzendahl, C. (2019). Acceptance and Rejection: Patterns of opinion on homosexuality in the United States and the world. Sociological Forum, 34(4), 1026-1031. doi:10.1111/socf.12562 [9] Lee, J., et al. [10] Lee, J., et al. [11] Lee, J., et al. [12] Lee, et al. [13] Lee, et al. [14] Lee, et al. [15] LGBTQ family building survey. (2020, July 02). Retrieved April 08, 2021, from https://www.familyequality.org/resources/lgbtq-family-building-survey/ [16] LGBTQ family building survey. (2020, July 02). Retrieved April 08, 2021, from https://www.familyequality.org/resources/lgbtq-family-building-survey/ [17] LGBTQ family building survey. (2020, July 02). Retrieved April 08, 2021, from https://www.familyequality.org/resources/lgbtq-family-building-survey/ [18] Mackenzie, S. C., Wickins-Drazilova, D., & Wickins, J. (2020). The ethics of fertility treatment for same-sex male couples: Considerations for a modern fertility clinic. European Journal of Obstetrics & Gynecology and Reproductive Biology, 244, 71-75. doi:10.1016/j.ejogrb.2019.11.011 [19] Mackenzie, et al. [20] Ollove, M. (2015, March 18). States not eager to regulate fertility industry. Retrieved April 08, 2021, from https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/3/18/states-not-eager-to-regulate-fertility-industry [21] Ollove, M. [22] Ollove, M. [23] World Health Organization. (2020, September 14). Infertility. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/infertility [24] Leondires, M. P. (2020, March 19). Fertility insurance Mandates & same-sex couples. Retrieved April 08, 2021, from https://www.gayparentstobe.com/gay-parenting-blog/fertility-insurance-mandates-same-sex-couples/ [25] Lo, W., & Campo-Engelstein, L. (2018). Expanding the Clinical Definition of Infertility to Include Socially Infertile Individuals and Couples. Reproductive Ethics II, 71–83. https://doi.org/10.1007/978-3-319-89429-4_6 [26] Mohapatra, S. (2015). Assisted Reproduction Inequality and Marriage Equality. Chicago-Kent Law Review, 92(1). Retrieved April 08, 2021, from https://scholarship.kentlaw.iit.edu/cgi/viewcontent.cgi?article=4146&context=cklawreview [27] Mohapatra, S. [28] Mohapatra, S. [29] Mohapatra, S. [30] Mohapatra, S. [31] Governor Cuomo announces new actions to expand access to FERTILITY coverage for same sex couples as part of 2021 Women's Agenda. (n.d.). [32] Health Insurers FAQs: IVF and Fertility Preservation Law Q&A Guidance. (n.d.). Retrieved April 08, 2021, from https://www.dfs.ny.gov/apps_and_licensing/health_insurers/ivf_fertility_preservation_law_qa_guidance [33] Governor Cuomo announces new actions to expand access to FERTILITY coverage for same sex couples as part of 2021 Women's Agenda. (n.d.). Retrieved April 08, 2021, from https://www.governor.ny.gov/news/governor-cuomo-announces-new-actions-expand-access-fertility-coverage-same-sex-couples-part#:~:text=February%2011%2C%202021-,Governor%20Cuomo%20Announces%20New%20Actions%20to%20Expand%20Access%20to%20Fertility,Part%20of%202021%20Women's%20Agenda&text=Cuomo%20today%20directed%20the%20Department,wish%20to%20start%20a%20family. [34] Leondires, M. P. [35] Assisted reproduction parentage proceedings information: Academy of Adoption and Assistive Reproduction Attorneys (AAAA). (2019, March 14). Retrieved April 08, 2021, from https://adoptionart.org/assisted-reproduction/parentage-proceedings/ [36] Assisted reproduction parentage proceedings information. [37] Governor Cuomo reminds surrogates and parents of their new Insurance rights and protections During Gestational Surrogacy. (n.d.). Retrieved April 08, 2021, from https://www.governor.ny.gov/news/governor-cuomo-reminds-surrogates-and-parents-their-new-insurance-rights-and-protections-during [38] U.S. Surrogacy Map: Surrogacy laws by state. (2020, December 23). Retrieved April 08, 2021, from https://www.creativefamilyconnections.com/us-surrogacy-law-map/ [39] Mohapatra, S. [40] Beitsch, R. (2017, June 29). As surrogacy surges, new parents seek legal protections. Retrieved April 08, 2021, from https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2017/06/29/as-surrogacy-surges-new-parents-seek-legal-protections#:~:text=Medicaid%20does%20not%20cover%20surrogacy,and%20intended%20parents%20at%20risk. [41] Where to find surrogacy insurance? (2017, November 02). Retrieved April 08, 2021, from https://surrogate.com/intended-parents/surrogacy-laws-and-legal-information/where-can-i-find-surrogacy-insurance/ [42] Mohapatra, S. [43] International covenant on civil and political rights. (n.d.). Retrieved April 08, 2021, from https://www.ohchr.org/en/professionalinterest/pages/ccpr.aspx [44] United Nations. (2003). Human rights in the administration of justice: a manual on human rights for judges, prosecutors and lawyers. [45] U.S. Const. amend. XIV, § 1. [46] Skinner v. Oklahoma, Https://caselaw.findlaw.com/us-supreme-court/316/535.html (June 1, 1942). [47] Skinner v. Oklahoma [48] Skinner v. Oklahoma [49] Eisenstadt v. Baird, Https://www.lexisnexis.com/community/casebrief/p/casebrief-eisenstadt-v-baird (March 22, 1972). [50] Obergefell v. Hodges [51] Higgins, T. (2021, June 17). Supreme Court sides with Catholic adoption agency that refuses to work with LGBT couples. CNBC. https://www.cnbc.com/2021/06/17/supreme-court-sides-with-catholic-adoption-agency-that-refuses-to-work-with-lgbt-couples.html. [52] Bowerman, M., May, A., & Rossman, S. (2017, April 24). Should the definition of infertility be more inclusive? USA Today. https://www.usatoday.com/story/news/nation-now/2017/04/22/same-sex-couples-covered-infertility-insurance/100644092/. [53] Mackenzie, et al. [54] Mackenzie, et al.