Genetic technologies and the regulation of reproductive decision-making in Australia

This article provides a critical analysis of the current Australian regulatory landscape at the interface between genetics and reproductive decision-making. The authors argue that a comparative analysis with other countries and international law and a contextual examination of the way law regulates concepts such as disease and health, abnormality and normality is necessary before we can develop appropriate policy and legislative responses in this area. Specific genetic testing technologies are considered including prenatal genetic testing, preimplantation genetic diagnosis and inheritable genetic modification. An increasing number of members of the Australian community are using genetic testing technologies when they decide to have a baby. The authors argue that as concepts of disease and health vary among members of the community and the potential to test for traits other than illness increases, a new tension arises between an ethic of individual choice and a role for government in regulating reproductive decision-making.     

Conceiving harm: disability discrimination in assisted reproductive technologies

Applying the Americans with Disabilities Act (ADA) to denials of treatment by assisted reproductive technology (ART) practitioners raises particularly challenging legal and ethical issues. On the one hand, the danger that physicians will inappropriately deny treatment to patients with disabilities is especially worrisome in the context of ARTs, given the widespread stigma associated with reproduction by individuals with disabilities. On the other hand, patients' disabilities may sometimes have potentially devastating implications for any child resulting from treatment, including the possibility that the child will be born with life-threatening or seriously debilitating impairments. Some physicians have strong ethical objections to helping patients become pregnant in the face of such risks. In this Article, Professor Coleman develops a framework for applying the ADA to disability-based denials of ARTs that addresses these competing considerations. In recognizing risks to the future child as a potential defense to a disability discrimination claim, Professor Coleman rejects the view of some commentators that such risks are relevant to reproductive decisions only if the child is likely to suffer so much that he or she would prefer not to exist. Instead, he proposes that, when a patient's disabilities create significant risks to the future child, the question should not be whether the child's life is likely to be so awful that nonexistence would be preferable, but how the risks and benefits of the requested treatment compare to those associated with other available reproductive and parenting options. Professor Coleman provides a theoretical justification for adopting this comparative framework, and examines how ADA precedents developed in other contexts should be applied to decisions about ARTs.     

Euthanasia as a Serious Homicide: An Empirical Study of (Normative) Consensus in Israel

The present study tests the applicability of the consensus versus the conflict model of criminal law in the case of homicide, and euthanasia, in particular. Although most criminal statutes consider euthanasia to be a serious homicide, many studies have revealed increasing public support for it. A survey of a national sample of Israeli respondents, based on a factorial design methodology, was conducted to determine the extent to which the criminal law reflects general or particular public attitudes toward euthanasia. The findings revealed that although social groups varied in their views on the seriousness of euthanasia, the public at large perceived it as significantly less serious than any other type of homicide. These findings are compatible with calls for reassessment of the criminal law with regard to euthanasia.     

Assisted reproductive technologies: professional and legal restrictions in Australian clinics

The professional and legal regulation of assisted reproductive technologies (ART) in Australia is a vast maze of intersecting laws and guidelines which place restrictions on the provision of services such as infertility treatment, surrogacy, sex selection for social reasons, donor insemination, pre-implantation diagnosis and human embryo research. This study investigated the application of these restrictions on clinical practice in New South Wales, a relatively unregulated State, and Victoria, a relatively highly regulated State. The results of the survey indicate that the range of ART services in Victorian clinics was far more limited than in New South Wales clinics. The Victorian clinics uniformly restricted access of single and lesbian women and did not offer social sex selection procedures. The New South Wales clinics adopted different polices regarding these services. It was found that restrictive laws governing "social" issues have a significant impact on the availability of ART services and some respondents seemed unclear about the nature of restrictions and laws relevant to their work. It was also found that "reproductive tourism" is prevalent and restrictions were circumnavigated by patients with assistance from clinics. It was concluded that more evidence is required to evaluate regulation in this field of medicine.     

Assisted reproductive technologies and the pitfalls of unregulated biomedical innovation

This Article suggests that the time has come to reconsider the safety and effectiveness of fertility drugs in order to combat some of the continuing problems arising from the overly aggressive use of assisted reproductive technologies, especially the health hazards associated with multifetal pregnancies. After critically assessing the arguments made by some commentators about the power of malpractice law to curb any abuses of fertility clinics and specialists, the Article concludes that the Food and Drug Administration should consider restricting or withdrawing pharmaceutical products used to induce ovulation. Although such a drastic move would not prevent the continued use of in vitro fertilization and other advanced fertility treatments, it would dramatically reduce the frequency of multifetal pregnancies, and it should not run afoul of any constitutional protections of procreative liberty.