Infertility, assisted reproduction and rights

The rights to reproduce and found a family are recognized as basic human rights. Infertile couples should enjoy the same right to reproduce as those who have the ability to do so without assistance. Both positive and negative rights to access to assisted reproductive technologies are required in order to fully realize the reproductive rights. However, there is a limit to such a claim. The positive right of individuals to have state-funded assisted reproductive treatments has to be balanced against the provision of other societal goods and healthcare rationing. The negative right to acquire access to assisted reproductive technologies by individuals' own resources is also restrained. The barrier to such access is often of a moral nature, the standard of which depends on the values of the society.     

Human rights and abortion laws.

Human rights protections have developed to resist governmental intrusion in private life and choices. Abortion laws have evolved in legal practice to protect not fetuses as such but state interests, particularly in prenatal life. National and international tribunals are increasingly called upon to resolve conflicts between state enforcement of continuation of pregnancy against women's wishes and women's reproductive choices. Legal recognition that human life begins at conception does not resolve conflicts between respect due to women's reproductive self-determination and due to prenatal life. Human rights protect healthcare providers' claims to conscientious objection, but not at the cost of women's lives and enduring health.     

Human rights aspects of safe motherhood

Maternal deaths in developing countries are often the ultimate tragic outcome of the cumulative denial of women's human rights. Women are not dying because of untreatable diseases. They are dying because societies have yet to make the decision that their lives are worth saving. Maternity is a social function and not a disease. When women are risking death to give life, they are entitled to have their own right to life and health protected. Societal attitudes of looking at women as means and not ends have resulted in the denial of women's rights to essential maternity services. A signal of hope is that safe motherhood is now on the world agenda as one of eight Millennium Development Goals. The global community of obstetricians has a major responsibility to help make motherhood safer for all women.     

Human rights begin at birth: international law and the claim of fetal rights

In the Universal Declaration of Human Rights, the foundation of human rights, the text and negotiating history of the "right to life" explicitly premises human rights on birth. Likewise, other international and regional human rights treaties, as drafted and/or subsequently interpreted, clearly reject claims that human rights should attach from conception or any time before birth. They also recognise that women's right to life and other human rights are at stake where restrictive abortion laws are in place. This paper reviews the International Covenant on Civil and Political Rights, the Convention on the Rights of the Child, and the Convention on the Elimination of All Forms of Discrimination Against Women, the European Convention for the Protection of Human Rights and Fundamental Freedoms, the Inter-American Human Rights Agreements and African Charter on Human and People's Rights in this regard. No one has the right to subordinate another in the way that unwanted pregnancy subordinates a woman by requiring her to risk her own health and life to save her own child. Thus, the long-standing insistence of women upon voluntary motherhood is a demand for minimal control over one's destiny as a human being. From a human rights perspective, to depart from voluntary motherhood would impose upon women an extreme form of discrimination and forced labour.     

Human rights to safe motherhood.

Each year an estimated 515000 women die of complications of pregnancy and childbirth, 7 million more suffer serious health problems and 50 million suffer adverse health effects. Over 98% of deaths occur in resource-poor countries. However, poverty alone neither justifies nor necessarily explains death rates. The Inter-Agency Group for Safe Motherhood, composed of six leading international agencies, has identified major medical causes of unsafe motherhood, and their origins in medical and health system failures, and in the failures of social justice that underlie them. These include women's 'inadequate education, low social status, and lack of income and employment opportunities.' This paper addresses the role of human rights to redress inequities that condition unsafe motherhood, and identifies five critical rights the observance of which would facilitate safe motherhood. These are women's rights to life, to liberty and security of the person, and to health, maternity protection and non-discrimination.     

Human rights to in vitro fertilization

The Inter-American Court of Human Rights (the Court) has ruled that the Supreme Court of Costa Rica’s judgment in 2000 prohibiting in vitro fertilization (IVF) violated the human right to private and family life, the human right to found and raise a family, and the human right to non-discrimination on grounds of disability, financial means, or gender. The Court’s conclusions of violations contrary to the American Convention on Human Rights followed from its ruling that, under the Convention, in vitro embryos are not “persons” and do not possess a right to life. Accordingly, the prohibition of IVF to protect embryos constituted a disproportionate and unjustifiable denial of infertile individuals’ human rights. The Court distinguished fertilization from conception, since conception—unlike fertilization—depends on an embryo’s implantation in a woman’s body. Under human rights law, legal protection of an embryo “from conception” is inapplicable between its creation by fertilization and completion of its implantation in utero.     

UN Human Rights Committees advance reproductive rights

The significance of working with human rights covenants to advance reproductive health and self-determination has gained momentum through the work of: i) the Human Rights Committee, which monitors compliance of States with-their obligations under the International Covenant on Civil and Political Rights, and ii) the Committee on the Elimination of Discrimination against Women (CEDAW), which was established to monitor States' compliance with the Convention on the Elimination of All Forms of Discrimination Against Women. In 1996, in its ‘Concluding Observations’ on the third report of the Government of Peru, the Human Rights Committee recommended that Peru ensure that women do not risk their life because of the existence of restrictive legal provisions on abortion. CEDAW, in a meeting in January 1997, addressed law policy related to reproductive rights in Morocco, Venezuela, St Vincent and the Grenadines, Turkey and the Philippines, not only in relation to laws that make abortion dangerous but also maternal mortality more broadly, contraception and access to reproductive and sexual health services.     

Human rights in the world of the genetic revolution

The Biotechnological Revolution provides enormous possibilities to human development (nutrition, medicine, industry), while at the same time, creates social-ethical apprehensions due to the dangers to Human Rights that an improper use could generate. In this respect, Human Rights are presented as the "religion" of our time: accepted by all, although not equally practised. These rights, classified in the Universal Declaration of the United Nations, are the terms which society uses to ponder the ethical peformance of individuals and organizations. Harmonisation between Biotechnology and Human Rights should be based on a continuous social debate in which the principles that contribute to the respect of the human's essential nature should arise. As a starting point, considerations concerning the repercussions which the different genetic techniques have on each of the individually considered Human Rights, i.e. on dignity, equality, freedom, the right to health, to intimacy or to a worthy environment should be developed. Moreover, an international vision of the problem should be imposed since it should be remembered that initiatives that avoid attacks on Human Rights are either taken internationally or are condemned to failure. The following work was not written to give practical solutions to ethical conflicts but simply to consider some of the aspects which can create controversy in the search for a coherent future for human nature.     

Human rights and the omission or cessation of treatment for infants

Advances in neonatal medicine have led to the survival of children who suffer pain and psychosocial deficits. There are those who justify the continued existence of these children by denying that there is a minimal quality of life below which life is not worth living or by claiming that we cannot judge the quality of life of another. Both of these viewpoints are found wanting. What is proposed is that infants are persons and that personhood confers human rights which include the right to die. The nature of human rights yields a general criterion by which to determine when the omission or cessation of treatment for infants is morally required.     

Procedural abortion rights: Ireland and the European Court of Human Rights

The Irish Protection of Life During Pregnancy Act seeks to clarify the legal ground for abortion in cases of risk to life, and to create procedures to regulate women’s access to services under it. This article explores the new law as the outcome of an international human rights litigation strategy premised on state duties to implement abortion laws through clear standards and procedural safeguards. It focuses specifically on the Irish law reform and the jurisprudence of the European Court of Human Rights, including A. B. and C. v. Ireland (2010). The article examines how procedural rights at the international level can engender domestic law reform that limits or expands women’s access to lawful abortion services, serving conservative or progressive ends.     

Human reproduction: a comparative background for medical hypotheses

Successful reconstruction of any aspect of human evolution requires broad-based comparisons with other primates and other eutherian mammals. If quantitative data are involved, the scaling influence of body size must be taken into account, and bivariate allometric analysis is a very useful tool. Broad-based comparisons lead to recognition of general principles that can feed into hypotheses concerning human reproductive medicine. Here, this approach is applied to basic life-history parameters (age at sexual maturity, gestation period, litter size, lactation period, interbirth interval, maximum lifespan), testicular dimensions and male mating strategies, female ovarian processes and mating cycles, placentation and embryonic/fetal development, gestation periods and neonatal condition, and brain development in relation to reproduction. Comparisons reveal that some features claimed to be unique to human beings in fact occur more widely in primates, such as 'loss of oestrus', which probably evolved in the common ancestor of higher primates (monkeys, apes and humans). Although humans show an extreme condition, in most higher primates mating is not strictly confined to the periovulatory period. Because this condition introduces the danger of fertilization with ageing gametes, it must have been favoured by strong selection and accompanied by the evolution of compensatory mechanisms. Overall, it seems likely that the high incidence of pre-eclampsia in human pregnancies is attributable to a partial failure of compensatory mechanisms associated with highly invasive placentation.     

Human immunodeficiency virus and assisted reproduction: reconsidering evidence, reframing ethics

OBJECTIVE: To review the advances in the treatment of human immunodeficiency virus (HIV) infection and revisit the medical, ethical, and legal issues surrounding infertility management in HIV-infected couples. DESIGN: Analytic review. RESULTS(S): HIV infection continues to be a serious public health and reproductive issue. However, present policies which allow for the categorical exclusion of HIV-infected individuals from infertility services should be reconsidered in light of improvements in the prognosis of infected individuals and a dramatic decrease in the risk of vertical transmission. An analysis of the ethical cogency of the arguments against the provision of services does not substantiate the exclusion of HIV-infected individuals; rather, the principle of justice requires that HIV-infected women be treated the same way as a woman who might have an increased risk of conceiving a child with a disability or a may have a decreased life expectancy due to a chronic illness such as diabetes. Ethical disagreement notwithstanding, with the precedents recently established by the Americans with Disabilities Act (ADA), discrimination based on HIV status would also likely be unlawful under most circumstances. CONCLUSIONS(S): With advances in the treatment of HIV infection, contextualized counseling and a respect for patients' decisions regarding infertility treatment should be adopted as public policy. It is neither ethically nor legally justifiable to categorically exclude individuals from infertility services on the basis of HIV infection.