New Belgian law on research on human embryos: trust in progress through medical science.

The new Belgian law on research on embryos in vitro accepts all types of research directed at therapeutic purposes and at increased medical knowledge. This includes research for germline and somatic gene therapy, therapeutic cloning, and the development of embryonic stem cell lines. As this presupposes the creation of embryos for research, this too is allowed.

Evolving ethics in medically assisted reproduction.

Ethical problems arising from the application of assisted reproductive technology are discussed for four specific areas, namely embryo research, multiple pregnancies, preimplantation genetic diagnosis (PGD) for social sexing, and finally PGD with HLA typing.

Taskforce 5: preimplantation genetic diagnosis.

The European Society of Human Reproduction and Embryology (ESHRE) Ethics Task Force sets out a recommended multidisciplinary approach to the application of preimplantation genetic diagnosis (PGD). The statement includes consideration of fundamental ethical principles, specific problems in cases of high genetic risk, and PGD for aneuploidy screening, HLA typing and sex selection for non-medical reasons.

Ovarian tissue cryopreservation: therapeutic prospects and ethical reflections.

Along with improved survival, methods to preserve or restore the fertility potential of young women and children treated with cytotoxic chemotherapy or pelvic radiotherapy have been developed or are in the offing. Surgery, radiotherapy and chemotherapy can all impact on the future ovarian function, but patient and disease tailored application and use of preventive measures can limit ovarian damage. When the loss of reproductive ovarian function is unavoidable, different alternatives to preserve fertility or at least to restore the procreative potential are available.

Incest, gamete donation by siblings and the importance of the genetic link.

Recently, several requests have emerged in which women wished to be impregnated with donor eggs fertilized with spermatozoa of their brother. An important argument advanced against such applications is that it is a kind of incest. Four definitions of incest are reviewed in this article to evaluate the acceptability of these demands.

Reproductive tourism as moral pluralism in motion.

Reproductive tourism is the travelling by candidate service recipients from one institution, jurisdiction, or country where treatment is not available to another institution, jurisdiction, or country where they can obtain the kind of medically assisted reproduction they desire. The more widespread this phenomenon, the louder the call for international measures to stop these movements. Three possible solutions are discussed: internal moral pluralism, coerced conformity, and international harmonisation.

Personal desires of patients and social obligations of geneticists: applying preimplantation genetic diagnosis for non-medical sex selection.

The arguments against the use of preimplantation genetic diagnosis (PGD) for non-medical sex selection are analysed. It is concluded that the distinction between medical and non-medical reasons is difficult to maintain, that the disproportionality of means and end is not a decisive counterargument and that the fear of damage to the reputation of PGD does not justify the refusal of controversial applications. Moreover, since non-medical sex selection does not belong to basic health care, it should not be equally accessible to all.

The validity of contracts to dispose of frozen embryos.

The widespread abandonment of frozen embryos by the gamete providers or intentional parents urgently demands a solution. Most centres react by requiring patients to enter a prior agreement governing the future disposition of their embryos in all foreseeable circumstances. These dispositional directives are inappropriate and self defeating in the event of contingencies in which the patients remain competent to execute an updated directive.

Ethical considerations on preimplantation genetic diagnosis for HLA typing to match a future child as a donor of haematopoietic stem cells to a sibling.

Recently, several requests were made by couples with an affected child who wanted preimplantation genetic diagnosis (PGD) to select embryos in the hope of conceiving an HLA identical donor sibling. This article considers the ethical arguments for and against the application of PGD for this goal. Only embryos HLA matched with an existing sibling in need of a compatible donor of haematopoietic stem cells would be transferred.

Postmenopausal women and the right of access to oocyte donation.

This paper raises the question of distributive justice in the allocation of donor oocytes. The shortage of oocytes has resulted in waiting lists of several years. The largest group of candidate recipients are postmenopausal women.

The right to privacy and access to information about one's genetic origins.

The right to privacy contains different dimensions. Best known are the possibility to restrict the flow of personal information to others (limited access by others) and the right not to know certain information gathered about oneself. Since the privacy right is meant to protect the identity, self-image and personal life of the person, he should also have the right to know certain facts about himself.

Distributive justice in the allocation of donor oocytes.

Due to the shortage of oocyte donors, the waiting lists are lengthening. This raises the ethical question of how the available oocytes should be distributed among candidate recipients. The paper clarifies the ethical structure of the allocation process to find a set of rules that generates decisions that are acceptable for all people involved.

Avoiding multiple pregnancies in ART: multiple pregnancies: a test case for the moral quality of medically assisted reproduction.

Although most professional societies have issued guidelines to diminish the number of embryos to be transferred during assisted reproduction techniques, the incidence of multiple pregnancies remains unacceptably high. The negative psychological, social and medical consequences for the patients and their offspring easily outweigh the benefits in terms of increased success rates. Multiple pregnancies would never be tolerated if the 'best interest of the child' standard was applied as strictly to these consequences, as it is to controversial family forms.

The 'double track' policy for donor anonymity.

Although there is no evidence that any one policy is the best solution, clinics as well as legislators tend to impose one position about donor anonymity on all participants. The most evident alternative policy is to let the parties decide for themselves. Donors may choose between anonymity or identification and recipients can opt for an anonymous or identifiable donor.

Gamete donation from couple to couple in the new French law.

In practice, the partners or spouses of gamete donors are frequently asked permission for the donation. The new French law on bioethics of 29 July 1994 requires that: a) the donor should be one of a couple that has already procreated and b) the written consent of the partner or spouse is obtained. These conditions lead not only to several practical problems in the organisation of donor insemination but also reject a large part of the potential donor population.

Partner consent for sperm donation.

The current practice of demanding the consent of the spouse for sperm donation is analysed. Three aspects of marriage may be involved: (i) sexual exclusivity and adultery, (ii) family composition and (iii) procreational exclusivity. The different justifications for giving the partner the right to participate in the decision-making process are critically scrutinized.

Should donors have the right to decide who receives their gametes?

A continuing feature of gamete donation is the scarcity of available donors. A strategy to improve the meagre supply of gametes would be to adjust the donation procedure to the wishes and desires of the donors. However, giving donors the right to direct their gametes to certain groups of recipients goes against the general rule that donors relinquish all rights and duties.