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Daar J. Where Does Life Begin? Discerning the Impact of Dobbs on Assisted Reproductive Technologies. J Law Med Ethics 2023; 51:518-527. [PMID: 38088601 DOI: 10.1017/jme.2023.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
This article explores the impact of Dobbs on access to assisted reproductive technologies. Clinical aspects of IVF, including embryo discard and cryopreservation, preimplantation genetic testing, and selective reduction of multiple pregnancy are potentially jeopardized by a new legal landscape that protects embryos over the interest of infertility patients.
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Affiliation(s)
- Judith Daar
- NORTHERN KENTUCKY UNIVERSITY, HIGHLAND HEIGHTS, KY, USA
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Klipstein S, Daar J. Impact of shifting legal and scientific landscapes on in vitro fertilization litigation. Fertil Steril 2023; 119:581-582. [PMID: 36690135 DOI: 10.1016/j.fertnstert.2023.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Affiliation(s)
| | - Judith Daar
- Ambassador Patricia L. Herbold Dean and Professor of Law, Northern Kentucky University, Chase College of Law, Highland Heights, Kentucky
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Affiliation(s)
- I Glenn Cohen
- Harvard Law School, Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard University, Cambridge, Massachusetts
| | - Judith Daar
- Salmon P. Chase College of Law, Northern Kentucky University, Highland Heights
| | - Eli Y Adashi
- Department of Medical Science, Brown University, Providence, Rhode Island
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Rajczi A, Daar J, Kheriaty A, Dastur C. The University of California Crisis Standards of Care: Public Reasoning for Socially Responsible Medicine. Hastings Cent Rep 2021; 51:30-41. [PMID: 34529849 DOI: 10.1002/hast.1284] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
During the Covid-19 pandemic, the University of California convened the University of California Critical Care Bioethics Working Group, a team of twenty individuals tasked with developing a set of triage procedures. This article highlights several crucial components of the UC procedures and describes the reasoning behind them. The recommendations and the reasoning in the UC protocol are distinctive because of the emphasis the working group placed on grounding its decisions on the public's preferences for triage protocols. To highlight the distinctiveness of the recommendations and reasoning, this article contrasts the UC procedures with the triage procedures known as the "Pittsburgh framework." Among the specific topics discussed are age discrimination, disability discrimination, the prioritization of critical workers for scarce resources, and triage priority for pregnant patients.
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Daar J. Physician autonomy or discrimination: the risks and limits of saying "no". Fertil Steril 2021; 115:263-267. [PMID: 33579519 DOI: 10.1016/j.fertnstert.2020.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/18/2020] [Indexed: 11/28/2022]
Abstract
Respect for patient autonomy is a critical concept in the training of all physicians. Most physicians will make clinical recommendations on a daily basis that reflect a marriage of evidence-based medical fact and the deeply felt aspirations and boundaries that patients share with them. While most physicians are well versed and comfortable managing issues of patient autonomy, many are less confident about ethical and legal guidelines for expressing their own autonomy in clinical decision-making. This paper will review the legal landscape surrounding the patient-physician relationship with a focus on when and how physicians can exercise their personal and professional autonomy in their clinical practice.
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Affiliation(s)
- Judith Daar
- Chase College of Law, Northern Kentucky University, Highland Heights, Kentucky
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Daar J. Legal liability landscape and the person/property divide. F S Rep 2020; 1:61-62. [PMID: 34223218 PMCID: PMC8244309 DOI: 10.1016/j.xfre.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Judith Daar
- Northern Kentucky University Salmon P. Chase College of Law, Highland Heights, Kentucky
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Amato P, Daar J, Francis L, Klipstein S, Ball D, Rinaudo P, Rajovic A, Palmore M, Tipton S, Coutifaris C, Reindollar R, Gitlin S, Daar J, Collins L, Davis J, Davis O, Francis L, Gates E, Ginsburg E, Gitlin S, Klipstein S, McCullough L, Paulson R, Reindollar R, Ryan G, Sauer M, Tipton S, Westphal L, Zweifel J. Ethics in embryo research: a position statement by the ASRM Ethics in Embryo Research Task Force and the ASRM Ethics Committee. Fertil Steril 2020; 113:270-294. [DOI: 10.1016/j.fertnstert.2019.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/04/2019] [Indexed: 02/06/2023]
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Daar J, Benward J, Collins L, Davis J, Davis O, Francis L, Gates E, Ginsburg E, Gitlin S, Hurd W, Klipstein S, McCullough L, Reindollar R, Ryan G, Sauer M, Tipton S, Westphal L, Zweifel J. Fertility treatment when the prognosis is very poor or futile: an Ethics Committee opinion. Fertil Steril 2019; 111:659-663. [DOI: 10.1016/j.fertnstert.2019.01.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/24/2019] [Indexed: 10/27/2022]
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Daar J, Benward J, Collins L, Davis J, Davis O, Francis L, Gates E, Ginsburg E, Gitlin S, Klipstein S, McCullough L, Paulson R, Reindollar R, Ryan G, Sauer M, Tipton S, Westphal L, Zweifel J. Consideration of the gestational carrier: an Ethics Committee opinion. Fertil Steril 2018; 110:1017-1021. [DOI: 10.1016/j.fertnstert.2018.08.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/09/2018] [Indexed: 11/16/2022]
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Daar J, Benward J, Collins L, Davis J, Davis O, Francis L, Gates E, Ginsburg E, Gitlin S, Klipstein S, McCullough L, Paulson R, Reindollar R, Ryan G, Sauer M, Tipton S, Westphal L, Zweifel J. Planned oocyte cryopreservation for women seeking to preserve future reproductive potential: an Ethics Committee opinion. Fertil Steril 2018; 110:1022-1028. [DOI: 10.1016/j.fertnstert.2018.08.027] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 11/25/2022]
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Daar J, Benward J, Collins L, Davis J, Davis O, Francis L, Gates E, Gitlin S, Ginsburg E, Klipstein S, McCullough L, Paulson R, Reindollar R, Ryan G, Sauer M, Sokol R, Tipton S, Westphal L, Zweifel J. Ethical obligations in fertility treatment when intimate partners withhold information from each other: an Ethics Committee opinion. Fertil Steril 2018; 110:619-624. [DOI: 10.1016/j.fertnstert.2018.06.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 11/30/2022]
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Abstract
Advancing technologies in genetic testing of preimplantation embryos enable IVF patients to access detailed information about their future child's health status, facilitating and complicating their reproductive decision-making. Testing for embryonic genetic anomalies linked to future health has grown increasingly sophisticated. A patient's decision to seek transfer of a health-affected embryo may or may not be compatible with her physician's professional conscience, potentially resulting in a clash at the petri dish. This article sets out arguments in support of physician decisions to assist or decline to assist in the transfer of anomalous embryos upon patient request. Arguments in support of transfer include the preeminence of a patient's reproductive liberty, the value of equal protection as applied to pre- and post-implantation embryos, the allocation of dispositional authority over embryos, and the frailties of predicting a child's future health experience. Arguments that bolster a provider's decision to decline requests for transfer include the role of physician autonomy in the doctor-patient relationship, the theories of reproductive non-maleficence and procreative beneficence, and legitimate concerns over future legal liability. Regardless of a clinic's ultimate position, this article advocates that providers create or adopt detailed policies setting forth their preferences and practices regarding anomalous embryo transfer.
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Affiliation(s)
- Judith Daar
- University of California, Irvine School of Law, 401 East Peltason Drive, Irvine, CA 92697, USA
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Daar J, Benward J, Collins L, Davis J, Davis O, Francis L, Gates E, Ginsburg E, Gitlin S, Klipstein S, McCullough L, Paulson R, Reindollar R, Ryan G, Sauer M, Tipton S, Westphal L, Zweifel J. Use of preimplantation genetic testing for monogenic defects (PGT-M) for adult-onset conditions: an Ethics Committee opinion. Fertil Steril 2018; 109:989-992. [DOI: 10.1016/j.fertnstert.2018.04.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 04/02/2018] [Indexed: 11/15/2022]
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Cohn F, Daar J. Ethics and Law: The Many Tensions. Am J Bioeth 2017; 17:77-79. [PMID: 28661740 DOI: 10.1080/15265161.2017.1314052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Daar J, Benward J, Collins L, Davis J, Francis L, Gates E, Ginsburg E, Klipstein S, Koenig B, La Barbera A, McCullough L, Reindollar R, Sauer M, Sokol R, Tipton S, Westphal L. Transferring embryos with genetic anomalies detected in preimplantation testing: an Ethics Committee Opinion. Fertil Steril 2017; 107:1130-1135. [DOI: 10.1016/j.fertnstert.2017.02.121] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/06/2017] [Indexed: 10/19/2022]
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Daar J, Benward J, Collins L, Davis J, Francis L, Gates E, Ginsburg E, Klipstein S, Koenig B, La Barbera A, McCullough L, Reindollar R, Sauer M, Sokol R, Tipton S, Westphal L. Oocyte or embryo donation to women of advanced reproductive age: an Ethics Committee opinion. Fertil Steril 2016; 106:e3-e7. [DOI: 10.1016/j.fertnstert.2016.07.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/01/2016] [Indexed: 11/29/2022]
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Daar J, Benward J, Collins L, Davis J, Francis L, Gates E, Ginsburg E, Klipstein S, Koenig B, La Barbera A, McCullough L, Reindollar R, Sauer M, Sokol R, Tipton S, Westphal L. Financial “risk-sharing” or refund programs in assisted reproduction: an Ethics Committee opinion. Fertil Steril 2016; 106:e8-e11. [DOI: 10.1016/j.fertnstert.2016.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 11/26/2022]
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Daar J, Amato P, Benward J, Collins L, Davis J, Francis L, Gates E, Klipstein S, Koenig B, McCullough L, Reindollar R, Sauer M, Sokol R, Tipton S. Defining embryo donation: an Ethics Committee opinion. Fertil Steril 2016; 106:56-58. [DOI: 10.1016/j.fertnstert.2016.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/07/2016] [Indexed: 11/26/2022]
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Daar J, Mutcherson K. INTRODUCTION: Intersections in Reproduction: Perspectives on Abortion and Assisted Reproductive Technologies. J Law Med Ethics 2015; 43:174-178. [PMID: 26242936 DOI: 10.1111/jlme.12230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Judith Daar
- Professor of Law at Whittier Law School and a Clinical Professor of Medicine at the University of California Irvine School of Medicine. She currently serves as Chair of the Ethics Committee of American Society for Reproductive Medicine and on the Society for Assisted Reproductive Technology's Committee on Informed Consent
| | - Kimberly Mutcherson
- Vice Dean and a Professor of Law at Rutgers School of Law in Camden, New Jersey. She earned a B.A. at the University of Pennsylvania and her J.D. at Columbia Law School. Her scholarly work is at the intersection of family law, health law, and bioethics
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Abstract
Enactment of mandated pre-procedure disclosures in abortion and assisted reproductive technology (ART) services has swelled in recent years. Calls to equally regard these mandates as neutral tools in furtherance of patient protection fail to acknowledge key substantive and structural differences in these reproduction-affecting mandates. While ART mandates permit physicians to use their medical judgment to protect presumptively vulnerable egg donors and gestational carriers, abortion disclosures impart scientifically suspect messaging aimed at dissuading women from pursuing pregnancy termination. These and other distinctions counsel in favor of regarding and analyzing abortion and ART mandated disclosures as separate and distinguishable informed consent tools.
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Affiliation(s)
- Judith Daar
- Professor of Law at Whittier Law School and a Clinical Professor of Medicine at the University of California Irvine School of Medicine. She currently serves as Chair of the Ethics Committee of American Society for Reproductive Medicine and on the Society for Assisted Reproductive Technology's Committee on Informed Consent
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Daar J. Physician duties in the face of deceitful gamete donors, disobedient surrogate mothers, and divorcing parents. Virtual Mentor 2014; 16:43-48. [PMID: 24433661 DOI: 10.1001/virtualmentor.2014.16.01.hlaw1-1401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Judith Daar
- Professor of law at Whittier Law School and a clinical professor of medicine in the School of Medicine at the University of California, Irvine and a member of the American Society for Reproductive Medicine Ethics Committee and past president of the American Society of Law, Medicine and Ethics
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Daar J. The outdated pregnancy: rethinking traditional markers in reproduction. J Leg Med 2014; 35:505-527. [PMID: 25517632 DOI: 10.1080/01947648.2014.981143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Abstract
This article explores the possibility that there is a parental duty to use preimplantation genetic diagnosis (PGD) for the medical benefit of future children. Using one genetic disorder as a paradigmatic example, we find that such a duty can be supported in some situations on both ethical and legal grounds. Our analysis shows that an ethical case in favor of this position can be made when potential parents are aware that a possible future child is at substantial risk of inheriting a serious genetic condition. We further argue that a legal case for a duty to use PGD for medical benefit can be made in situations in which potential parents have chosen to conceive through in vitro fertilization and know that any children conceived are at substantial risk of having a serious genetic condition.
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Affiliation(s)
- Janet Malek
- Brody School of Medicine, Bioethics and Interdisciplinary Studies, Greenville, NC 27834, USA.
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Brzyski R, Daar J. Reply of the Authors: Access to fertility treatment. Fertil Steril 2010. [DOI: 10.1016/j.fertnstert.2009.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Daar J. Sliding the slope toward human cloning. Am J Bioeth 2001; 1:23-24. [PMID: 11808584 DOI: 10.1162/152651601750078934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Abstract
Vanadyl sulfate was administered orally during a 10-week trial period to streptozotocin-diabetic and control male rats to test the hypothesis that chronic vanadyl supplementation would prevent the decline in cardiac muscle cell glucose transporter protein (GLUT-4) that otherwise manifests in conjunction with insulin deficiency. Isolated cardiac myocytes and cardiac sarcolemmal vesicles were prepared from heart tissue of rats that had been maintained on the following regimens: untreated control, oral vanadyl-supplemented control (0.6 mg/ml), untreated diabetic (streptozotocin-induced; 60 mg/kg), and vanadyl-supplemented diabetic. Myocytes isolated from untreated diabetic rat hearts had decreased rates of glucose oxidation. Chronic, oral administration of vanadyl to diabetic rats maintained glucose oxidation rates of cardiac myocytes at control levels. Immunoblot analyses revealed that total cardiac myocyte and sarcolemmal GLUT-4 glucose transporter protein levels were significantly lower in the diabetic group relative to control. Vanadyl treatment of diabetic rats produced a normalization of both sarcolemmal GLUT-4 and total cardiac myocyte levels towards control levels. The reduction of GLUT-4 mRNA levels seen with untreated diabetes was also completely prevented with vanadyl treatment. These results demonstrate that chronic-oral vanadyl sulfate supplementation limits the decline in glucose oxidative capacity of cardiac myocytes that otherwise manifests in the untreated diabetic state. This action of vanadyl may occur via a mechanism that is linked to the preservation of sarcolemmal GLUT-4 protein levels.
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Affiliation(s)
- S J Kopp
- Department of Physiology, Midwestern University, Downers Grove, IL 60515, USA
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