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Goedeke S, Shepherd D, Rodino IS. Fertility stakeholders' concerns regarding payment for egg and sperm donation in New Zealand and Australia. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2022; 14:8-19. [PMID: 34703916 PMCID: PMC8523861 DOI: 10.1016/j.rbms.2021.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/30/2021] [Accepted: 07/29/2021] [Indexed: 05/31/2023]
Abstract
New Zealand and Australia are countries which currently prohibit donor payment and require open-identity forms of donation. This study explored the concerns of fertility stakeholders regarding payment which would constitute financial reward for gamete donation, and factors predicting such concerns. A total of 434 participants from across New Zealand and Australia completed an online survey anonymously. Participants included those with infertility and treatment experience, donors, recipients, donor-conceived people and clinic professionals. Results indicated that participants' concerns related to their assumptions about the type of donor motivated by financial reward, and the possibility that, if paid, donors might conceal information relevant to treatment and the donor-conceived person. Furthermore, participants were concerned about increasing recipient costs. Participants with personal experience of infertility held stronger concerns overall. Professionals expressed concerns of clinical relevance, such as the withholding of donor information relevant to treatment outcomes. The lowest levels of concern were expressed in relation to payment devaluing the meaning of human life. Qualitatively, themes highlighted concerns regarding payment enticing the 'wrong' type of donor, increased cost to recipients, and concern about the wellbeing of donor-offspring. Collectively, such concerns must be understood against the New Zealand and Australia open-identity donation context which enables the possibility of contact between donors and offspring. These findings indicate that donor recruitment campaigns need to account for different stakeholder concerns, and consider ways to address donor shortages effectively while remaining compliant with legislative requirements.
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Affiliation(s)
- Sonja Goedeke
- Department of Psychology and Neuroscience, School of Clinical Sciences, Auckland University of Technology, New Zealand
| | - Daniel Shepherd
- Department of Psychology and Neuroscience, School of Clinical Sciences, Auckland University of Technology, New Zealand
| | - Iolanda S. Rodino
- Medical School, The University of Western Australia, Perth, WA, Australia
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Goedeke S, Shepherd D, Rodino IS. Support for recognition and payment options for egg and sperm donation in New Zealand and Australia. Hum Reprod 2020; 35:117-129. [DOI: 10.1093/humrep/dez257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/25/2019] [Indexed: 12/23/2022] Open
Abstract
Abstract
STUDY QUESTION
To what extent do infertility clinic patients, fertility industry professionals and members of the public support different forms of payment and recognition for egg and sperm donation?
SUMMARY ANSWER
While participants expressed support for reimbursement of expenses for both egg and sperm donation, payment constituting explicit financial advantage was regarded less favourably although potentially necessary to address donor gamete shortages.
WHAT IS KNOWN ALREADY
In both New Zealand and Australia, commercial inducement for the supply of gametes is prohibited. This prohibition has been argued to contribute to limited availability of donor gametes with the effect of increasing waiting lists and/or the pursuit of potentially unregulated cross-border reproductive care by domestic patients requiring donor gametes.
STUDY DESIGN, SIZE, DURATION
The study was a mixed methods study drawing on data from a questionnaire completed by 434 participants from across New Zealand and Australia between November 2018 and March 2019.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Stakeholders involved in donor-assisted conception (past and present infertility patients, gamete recipients and donors), fertility industry professionals and members of the public were recruited following online advertisement of the study. All participants spoke English and primarily identified as Caucasian. Participants anonymously completed an online questionnaire gauging their support for a range of recognition and payment options. Dependent samples t-tests were used to probe for differences in support of recognition and payment options in relation to egg and sperm donation. Linear regression models were used to determine factors predicting support for the different options for both egg and sperm donation. Thematic analysis was used to identify main themes in free text question responses.
MAIN RESULTS AND THE ROLE OF CHANCE
Broadly, there was agreement that donors be reimbursed for medical expenses, travel time, unpaid time away from work relating to treatments and out-of-pocket expenses directly related to the gamete donation process, with greater support suggested for egg versus sperm donors. Items gauging support for non-material recognition and tokens of thanks for donations were not significantly different between egg and sperm donation programmes (P > 0.05) nor rated as highly as reimbursement alternatives. Lowest ratings of support were indicated for the outright payment or reward of donors for the supply of their gametes, options that would leave donors in better financial positions. Qualitatively, themes valuing gamete donation as ideally relating to gifting were identified, although counterbalanced in opinion by concepts of fairness in reimbursing gamete donors for their costs. Where payment over and above the reimbursement of costs was supported, this was related to pragmatic considerations of limited supply of donor gametes.
LIMITATIONS, REASONS FOR CAUTION
This study used a cross-sectional design and consequently causal inferences cannot be made. Additionally, participants particularly professional fertility staff, were required to self-report on politically sensitive and legal issues with the potential for social desirability response bias. Snowball sampling may have led to participation of like-minded individuals, thus limiting generalizations of findings.
WIDER IMPLICATIONS OF THE FINDINGS
In a climate of global commercialization of reproductive medicine, limited donor gamete availability and rising incidences of cross-border reproductive care, the findings of this study can be used as a basis for further discussion between regulators and professional industry stakeholders with respect to shaping ethical policy and practice relating to donor conception.
STUDY FUNDING/COMPETING INTEREST(S)
No external funds were sought for this work. None of the authors have any competing interests to declare.
TRIAL REGISTRATION NUMBER
N/A.
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Affiliation(s)
- Sonja Goedeke
- Department of Psychology, Auckland University of Technology, Auckland, New Zealand
| | - Daniel Shepherd
- Department of Psychology, Auckland University of Technology, Auckland, New Zealand
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Nordqvist P. Un/familiar connections: on the relevance of a sociology of personal life for exploring egg and sperm donation. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:601-615. [PMID: 30801732 PMCID: PMC6850007 DOI: 10.1111/1467-9566.12862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In recent decades, reproductive medicine has become a widespread global phenomenon. Within the field, donor conception, and the use of donated eggs, sperm or embryos from a third party, plays a key role. Despite the importance of those individuals who donate, there has been scant research exploring their experiences. Seeking to contribute to the growing, albeit still small, body of research on donors, this paper advocates bringing the process of donating into dialogue with a sociology of personal life. It suggests that important new insights about the donor experience can be achieved by utilising such a theoretical perspective. The paper applies a broad framework of a sociology of personal life to demonstrate that the decision to donate reverberates within donors' everyday lives and relationships, and explores, primarily theoretically, how it is that acts of donation bring such issues into play. To this end, the paper examines in detail three ways in which donating interacts with dimensions that are integral to personal life: "living" genetic connectedness, relationality and the intimate body. Ultimately, the paper suggests that a sociology of personal life shows light on new, unexplored questions for this field that demand greater scholarly attention.
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The current status of oocyte banks: domestic and international perspectives. Fertil Steril 2018; 110:1203-1208. [DOI: 10.1016/j.fertnstert.2018.07.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/03/2018] [Accepted: 07/13/2018] [Indexed: 01/07/2023]
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Dasgupta K. Generosity and compliance: Recruitment-work and the pathways to participation in bone marrow donation. Soc Sci Med 2018; 206:86-92. [PMID: 29684652 DOI: 10.1016/j.socscimed.2018.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 04/09/2018] [Accepted: 04/12/2018] [Indexed: 11/18/2022]
Abstract
This study examines challenges involved in recruiting bone marrow donors. Data comes from participant observation with a recruitment organization in the United States. Findings reveal that recruiters try to express bone marrow donation with common "gift of life" messaging, which emphasizes a singular event involving generosity. Potential recruits, however, respond by focusing on pain and time commitments. These concerns draw attention to the many stages and requirements involved in bone marrow donation and make issues of compliance salient. The juxtaposition of generosity and compliance creates practical difficulties for recruiters. The study contributes to existing literature, by illustrating how logistics shape altruism and gift arrangements involved in medical donation.
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Affiliation(s)
- Kushan Dasgupta
- Department of Sociology, University of Southern California, 851 Downey Way, Hazel & Stanley Hall 314, Los Angeles, CA 90089-1059, USA.
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6
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Goedeke S, Daniels K. The Discourse of Gifting in Embryo Donation: The Understandings of Donors, Recipients, and Counselors. QUALITATIVE HEALTH RESEARCH 2017; 27:1402-1411. [PMID: 27738257 DOI: 10.1177/1049732316672646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In New Zealand, embryo donation (ED) is "open," allowing offspring to access genetic information. Donors and recipients meet prior to donation. Drawing on interviews with 15 recipients, 22 donors, and nine counselors, this article discusses how ED may be constructed as a form of gifting. This discourse may evoke expectations that recipients will express gratitude for the gift, including through honoring contact agreements. Donation becomes a relational practice of obligations and counter-obligations. However, the gift discourse may not adequately capture the emotional sacrifice experienced by donors. Donors describe significant attachment to their embryos, ambiguity about relinquishment, and interest in offsprings' welfare. Furthermore, embryos may be constructed as inalienable bodily gifts resulting in children with whom the donors share immutable social ties. A discourse of ED as mutual exchange, collaboration, and extended family building may be more useful to donors and recipients in managing ED.
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Affiliation(s)
- Sonja Goedeke
- 1 Auckland University of Technology, Auckland, New Zealand
| | - Ken Daniels
- 2 University of Canterbury, Christchurch, New Zealand
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Gonen LD. Donor insemination: Israel as a representative case of a competitive market examining the possibility of policy reform. J Comp Eff Res 2016; 6:145-164. [PMID: 27854130 DOI: 10.2217/cer-2016-0066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
AIM To measure the private and social benefits of donor insemination (DI). METHODS An empirical model investigates the general public and DI clients' willingness to pay (WTP) for DI, and the willingness of potential donors to become altruistic or paid sperm donors. RESULTS The general public and DI clients value DI and have a positive WTP for it, whereas willingness to donate, altruistically or for payment, is either low or very low. CONCLUSION The general public's and DI clients' WTP for DI is in average above actual cost, so the government should consider funding or subsidizing DI. The government should encourage altruistic gamete donation through information and education of all parties involved directly and indirectly in the process of donation whose ultimate goal is the birth of a child.
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Affiliation(s)
- Limor D Gonen
- Department of Economics & Business Administration, Ariel University, Israel
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8
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Koh SA, Sanders K, Deakin R, Burton P. Male age negatively influences clinical pregnancy rate in women younger than 40 years undergoing donor insemination cycles. Reprod Biomed Online 2013; 27:125-30. [DOI: 10.1016/j.rbmo.2013.04.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 03/15/2013] [Accepted: 04/25/2013] [Indexed: 11/28/2022]
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Riggs DW, Russell L. Characteristics of men willing to act as sperm donors in the context of identity-release legislation. Hum Reprod 2010; 26:266-72. [DOI: 10.1093/humrep/deq314] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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To name or not to name? An overview of the social and ethical issues raised by removing anonymity from sperm donors. Asian J Androl 2010; 12:801-6. [PMID: 20622888 DOI: 10.1038/aja.2010.60] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The aim of this paper is to focus on the ethical issues raised by the removal of anonymity from sperm donors. The increasing currency of a 'right to genetic truth' is clearly visible in the drive to revise the legislation on donor anonymity in Western and European countries. The ethical debate is polarized between the 'right to privacy' of the donor or parent and the 'right to know' of the prospective child. However, it is evident that religious, social and cultural attitudes have an overarching impact on attitudes towards sperm donation generally and anonymity specifically. In Asian countries, the social and cultural heritage is hugely diverse and different from those of the West. This review considers the research exploring the complexity of ethical issues informing this debate, and argues that parent's decisions to reveal donor insemination origins to their children are highly complex and relate to a range of social and cultural attitudes that have not been addressed within the policy to remove anonymity from sperm donors.
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11
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Keylor R, Apfel R. Male Infertility: Integrating an Old Psychoanalytic Story with the Research Literature. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/15240651003666326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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14
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Walker I, Broderick P. The psychology of assisted reproduction — or psychology assisting its reproduction? AUSTRALIAN PSYCHOLOGIST 2007. [DOI: 10.1080/00050069908257423] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
The practice of gamete donation has, until recently, been shrouded in secrecy. The stigma associated with infertility and, in particular, donor insemination has been the main factor contributing to this secrecy. Over the last 20 years, this secrecy and the anonymity of the gamete donors has been challenged. In the first instance, the challenge came from governments in some countries legislating to abolish donor anonymity. Counsellors, social workers and psychologists advocating for the interests and needs of children and their families, as well as parents who did not wish to keep gamete donation secret from their children, were also instrumental in the change of policies and practice. Those offspring who know that they were conceived as a result of gamete donation are also calling for an end to the secrecy. This chapter reviews the changes that have occurred and which are still occurring, and reviews the research associated with these changes.
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Affiliation(s)
- Ken Daniels
- School of Social Work and Human Services, University of Canterbury, Christchurch, New Zealand.
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Daniels K, Feyles V, Nisker J, Perez-Y-Perez M, Newton C, Parker JA, Tekpetey F, Haase J. Sperm Donation: Implications of Canada’s Assisted Human Reproduction Act 2004 for Recipients, Donors, Health Professionals, and Institutions. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2006; 28:608-615. [PMID: 16916485 DOI: 10.1016/s1701-2163(16)32199-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND On April 22, 2004, the Assisted Human Reproduction Act came into force, prohibiting the purchase of sperm or eggs from donors in Canada. In response to the concerns of medical professionals and some consumers that prohibiting payment would lead to a decline in the number of gamete donors, Health Canada commissioned research on altruistic donor recruitment and recruitment strategies. METHODS Twenty-two studies of sperm donors were located and their findings reviewed. The studies spanned 23 years (1980-2003), were undertaken in a range of countries, and were chosen on the merit of their relevance to the development of recruitment strategies within a policy of altruistic sperm donation. Observations were derived from assessing and comparing the purposes, findings, and implications of the 22 studies. RESULTS Payment for providing sperm was made in all but three studies, although participants in 15 studies indicated clearly that their motivations were primarily altruistic. Observations indicate that men who are more willing to be identified to offspring in the future share demographic characteristics, such as age and parental status, with those who are prepared to donate altruistically. These characteristics appear to be a factor in motivation to donate altruistically. CONCLUSION The studies show that there are men who are prepared to donate sperm without financial payment. The findings suggest that a change is required in the culture of sperm donation, specifically the adoption of a new approach to donor recruitment.
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Affiliation(s)
- K Daniels
- Department of Social Work, University of Canterbury, New Zealand
| | - V Feyles
- London Health Sciences Centre, London, ON
| | - J Nisker
- London Health Sciences Centre, London, ON
| | - M Perez-Y-Perez
- Department of Social Work, University of Canterbury, New Zealand
| | - C Newton
- London Health Sciences Centre, London, ON
| | - J A Parker
- London Health Sciences Centre, London, ON
| | - F Tekpetey
- London Health Sciences Centre, London, ON
| | - J Haase
- London Health Sciences Centre, London, ON
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17
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van den Akker O. A review of family donor constructs: current research and future directions. Hum Reprod Update 2005; 12:91-101. [PMID: 16172110 DOI: 10.1093/humupd/dmi038] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This review addresses research on gamete donors, recipients, and offspring and demonstrates that the foci on all three within the triad are largely directed at disclosure or anonymity; and each in turn centers on the perceived importance of the genetic link. The importance attached to genetics has led some countries to review the ethics of anonymous gamete donation (e.g. New Zealand's 'open system' of information sharing) and has led other countries (Sweden, Austria, Victoria, Australia; the Netherlands, the UK) to change their laws allowing donor gamete offspring the right to obtain identifying information about their genetic parent. This review demonstrates that genealogical inconsistencies between and within members of the triad are common regardless of legislation. A discussion of future trends and concerns, relating to the use of gamete donation and the effects legislation is likely to have on the donor triads in the UK following 2005, is provided. The review also addresses the importance of testing theoretical models within future research, and argues this would lead to a better understanding of the underlying problems encountered at a psychosocial level, such as continued preference for anonymity in donors and denial in large numbers of users of the involvement of a donor in conception. Lack of disclosure effectively prevents true implementation of legislation; if a child is not informed, it is the result of donated gametes, it cannot take up the legally available option of finding out identifiable information about their genetic parent(s).
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Affiliation(s)
- Olga van den Akker
- School of Life and Health Sciences, Aston University, Aston Triangle, Birmingham, UK.
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18
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Kirkman M. Parents’ contributions to the narrative identity of offspring of donor-assisted conception. Soc Sci Med 2003; 57:2229-42. [PMID: 14512252 DOI: 10.1016/s0277-9536(03)00099-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Donated sperm, eggs, and embryos are an increasing feature of assisted reproduction; people conceived in this way have different genetic and social histories. Although most offspring of donor-assisted conception are ignorant of their genetic history, recipient parents must negotiate increasing demand for full disclosure to offspring. This paper illustrates some of the reasons parents give for not telling their children, underlines the experience of many parents of being uncertain of how to go about telling, presents information from some parents who have endeavoured to be open with their children about conception from very early childhood, and discusses implications for the narrative identity of offspring of donor-assisted conception. Recipient parents (n=55) and offspring (12) from Australia; Canada, US, England, and Argentina were interviewed and subsequently consulted about the development of their narrative accounts and the way in which these have been interpreted. Parental narratives were found to be located along a continuum, broadly encompassing: (1). Parents who intend to exclude donor-assisted conception from the narratives they construct for their children, (2). parents who are uncertain about what they want to do, or confused about the best way to disclose and discuss donor conception with their children and (3). those have incorporated the donor in their children's narratives from the beginning. From interviews with offspring and on the basis of human rights issues and the increasing salience of genetic knowledge, it is concluded that disclosure to offspring before adolescence should be encouraged.
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Affiliation(s)
- Maggie Kirkman
- Key Centre for Women's Health in Society, University of Melbourne, 3010, Australia.
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Daniels KR, Blyth E, Hall D, Hanson KM. The best interests of the child in assisted human reproduction: the interplay between the state, professionals, and parents. Politics Life Sci 2000; 19:33-44. [PMID: 11789526 DOI: 10.1017/s0730938400008881] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Developments in assisted human reproduction (AHR) have aroused considerable debate and interest around the world, with most governments accepting that they are matters of public policy. This politicization of AHR is explored in the context of a consideration of the oft-used term "the best interests of the child." This "rallying call" is frequently cited as the primary concern in the determination of policy. This article is based on the contention that it is important to examine the interplay between the three main groups directly influencing "best interest" outcomes for AHR offspring. These groups are the professionals, the parents, and the state. It seeks to examine how this high-sounding and well-meaning commitment is addressed, advanced, or ignored in the interplay of these groups.
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Affiliation(s)
- K R Daniels
- Canterbury University, Private Bag 4800, Christchurch,New Zealand
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Kirk M. Relative concerns associated with genetics and surrogacy. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 1998; 7:717-22. [PMID: 9735720 DOI: 10.12968/bjon.1998.7.12.5662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Assisted reproductive technologies, incorporating artificial insemination and in-vitro fertilization techniques, are widely practised across Europe. Concern about surrogacy prompted the UK Government to commission a review and consultation on surrogacy arrangements. The ensuing document was concerned primarily with the questions of payment to the surrogate, and the regulation of agencies involved in surrogacy arrangements. This author feels that more fundamental issues should first be debated by both health professionals and society. Genetic aspects of surrogacy merit special attention, particularly regarding the genetic contribution to parenthood and the ownership and use of genetic information. Health professionals need to be fully aware of the ethical implications of advances in genetics and technology when they are applied to assisted reproduction.
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Affiliation(s)
- M Kirk
- School of Nursing and Midwifery, University of Glamorgan
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21
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Daniels K. The controversy regarding privacy versus disclosure among patients using donor gametes in assisted reproductive technology. J Assist Reprod Genet 1997; 14:373-5. [PMID: 9285318 PMCID: PMC3454779 DOI: 10.1007/bf02766141] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- K Daniels
- Department of Social Work, University of Canterbury, Christchurch, New Zealand
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