Legal Challenges In Contemporary Reproductive Medicine

Legal Challenges In Contemporary Reproductive Medicine Presented by: Dr. Vrtačnik Date: 21 March 2025 Introduction - 1978- First IVF procedures (Steptoe, Edvards, UK) - 1949- Fletcher's lectures (Harvard, US) - dealing with ethical issues on artificial insemination (first reports from Guttmacher, Stoughton and Kohlberg) - Steptoe and Edwards (Matter of Life, 1980): IVF procedures brought hope to thousands of (infertile) couples, but at the same time they triggered interests to million of others watching from the sidelines. Perpetual Issues - Procedures offered to the couples (type, conditions, limitations) - Individuals entitled to IVF (married couples, cohabiting, homosexual couples, single persons) - Donation/Storage (types of donation, conditions, time) - Posthumous procedures - Anonymity (of donors) - Surrogacy (absence of regulation, prohibition, regulation) - Testing and research (PGT-A (PGS); PGT-M (PGD); PGT-Sr (PGD); embryonic research) - Reimbursement of costs (financing of cycles) - Status of embryo (in ART) Individuals Entitled - Early legislations mostly offered IVF treatments (with own gametes) only to heterosexual couples; nowadays - tendency towards broadening of circle • Germany (+single women, female couples); • Benelux (+single women, female couples); • Spain (+single women, female couples); • Portugal (+single women, female couples); • Hungary (+single women); • Croatia (+single women) • Austria (+female couples); • Slovenia (decision of the CC from Oct 24 + single women, female couples); - Some countries differentiate re/f use of own gametes/donation (gametes/embryo) - No broadening to male couples (question of surrogacy) Donation - Quite some restrictions in early regulation, nowadays different solutions • Germany (sperm, embryo); • Benelux (sperm, oocyte, both); • France (sperm, oocyte, embryo) • Spain (sperm, oocyte, embryo); • Hungary (sperm, oocyte, both); • Croatia (sperm, oocyte, embryo) • Austria (sperm, oocyte, both); • Slovenia (sperm, oocyte); - Different conditions (per country, per type of donation); - Rising number of countries with embryo donation (strict conditions, court assessment/other controlling mechanisms) - Biological relation with one of the partners no longer a must Surrogacy - - Predominantly there was/is a ban on surrogacy agreements • Prevention from exploitation • Dignity (of surrogate mother) • Medical reasons - prevailing risks (on the side of surrogate mother) Certain EU states permitting altruistic surrogacy (Ireland, Greece, Cyprus, Portugal*) - ECHR case law set to recognize legal consequences of surrogacy performed abroad (parenthood) - On the other hand, there is strong initiative on universal ban of surrogacy (Casablanca declaration, 2023) based on legal, ethical and medical arguments Anonymity Of Donors - Anonymity issue spreads over two (rather) opposite rights: right to (undisturbed) family life and right to know your origin - Historically anonymity was a predominant solution - Nowadays (in gamete donation): - • Strict anonymity rule in 18 EU+ countries (medical exceptions); • Mixed system (anonymous and non-anonymous) in 13 EU+ countries • Non-anonymous only in 2 countries (Georgia and Netherlands) • Some countries with specific (complicated) rules Embryo donation (?): • Permitted in 29 countries (according to ESHRE); • No mixed system; • Strict anonymity of donors in 5 countries; • One country with non-anonymity (Romania); • Many countries with no data (not reliable information); Genetic Testing And Position Of Embryo - ECHR judgment in Costa and Pavan vs. Italy (2012) ruled that ban on genetic testing (for a known disease) is a violation of Art 8 of ECHR (Right to family life); it established right to bring a child into the world who is not affected by the illness that they carry - PGD (PGT-M, PGR-Sr) is therefore offered in many EU States (Germany, France, Spain, Hungary, Slovenia, Croatia ....), conditions for such testing vary - PGS (PGD-1) - testing (screening) for any disease - is predominantly banned due to ethical reasons (eugenics) - Legal (Status of embryo) • Discussion on this matter is sometimes avoided • Full status/No status/Limited status • Lack of independent rights of embryo in healthcare • Protection of embryo is regularly included in legislation in the fields of reproductive medicine Conclusion - Similar legal/ethical issues are debated since the beginnings of modern reproductive medicine - There has been some development (progress) in regulation - however no common rules are established - Common EU regulation on ART would be beneficial • There is no much (legal) grounds for differentiating individuals based on nationality/citizenship criteria - • Easier (and equitable) access to reproductive health; • Preventing negative impacts of reproductive tourism Still an area which is vulnerable to potential abuse (ethical standards must be respected consistently together with safeguards, provided by regulation)