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Transnational surrogacy, when people travel abroad for reproduction with the help of a surrogate mother, is a heavily debated phenomenon. One of the most salient discourses on surrogacy is the one affirming that Westerners, in their quest for having a child, exploit poor women in countries such as India. As surrogacy within the Swedish health care system is not permitted, Swedish commissioning parents have used transnational surrogacy, and the majority has turned to India. This interview study aimed to explore how commissioning parents negotiate the present discourses on surrogacy. Findings from the study suggest that the commissioning parents' views on using surrogacy are influenced by competing discourses on surrogacy represented by media and surrogacy agencies. The use of this reproductive method resulted, then, in some ambiguity. Although commissioning parents defy the exploitation discourse by referring to what they have learnt about the surrogate mother's life situation and by pointing at the significant benefits for her, they still had a request for regulation of surrogacy in Sweden, to better protect all parties involved. This study, then, gives a complex view on surrogacy, where the commissioning parents simultaneously argue against the exploitation discourse but at the same time are uncertain if the surrogate mothers are well protected in the surrogacy arrangements. Their responses to the situation endorse the need for regulation both in Sweden and India.

Dr. Kiken promised Ms. Richards and her husband that the conditions stated above would be met.5 Ms. Richards’ husband had hazel eyes and a pinkish skin tone.6 He was 5’11 and had an athletic build.7 His family was Norwegian, Irish, and English, and they were Christians.8 He was also musically gifted.9 In comparison, Dr. Kiken was shorter than Ms. Richards’ husband and was slender.10 He had brown eyes and an olive complexion.11 He was in his late 30s, and thus did not fall into the standard 22-28 age range a standard medical student or intern would be in.12 Dr. Kiken’s family was Jewish and he did not have a similar family background to Ms. Richards’ husband.13 Ms. Richards became pregnant on her second round of artificial insemination and gave birth to a daughter in 1980.14 Dr. Kiken told Ms. Richards and her husband that they could not tell anyone that they used a donor’s sperm unless there was a severe medical emergency. 15 Ms. Richards and her husband eventually went back to Dr. Kiken because they wanted to conceive a second child with the anonymous donor they had used before.16 Dr. Kiken told them that he had saved the donor’s “number,” and could thus use the same donor to help them conceive their second child.17 In 1981, Ms. Richards conceived a son, and Dr. Kiken allegedly led Ms. Richards and her husband to believe that their son was conceived from the same anonymous, healthy, young medical student or intern they had used before.18 In 2019, Ms. Richards’ daughter received a 23andMe DNA kit as a gift.19 The results of the test revealed that aside from her full-brother, who was Ms. Richards’ son, she also had a half-brother.20 Furthermore, the results showed that she was 50% Irish and French and 50% Ashkenazi Jewish, and that she was a carrier for Tay Sachs, which is a rare and serious genetic condition that is often passed through people with Jewish heritage.21 Ms. Richards was shocked when she learned about the results of the test because she believed Dr. Kiken representations that the sperm donor was Christian, in excellent health, and “medically cleared.” 22 At this time, she did not know nor did she suspect that Dr. Kiken used his own sperm to impregnate her.23 Around the same time Ms. Richards’ daughter received her results from 23andMe DNA, she was having serious health issues and needed to find out information about her family medical history, including the sperm donor’s medical history, in order to explore treatment options.24 Because Dr. Kiken had previously told Ms. Richards and her husband that they would be able to access the sperm donor’s medical information if their child was in danger, Ms. Richards contacted Dr. Kiken for help.25 She sent him a letter and asked for help in accessing information about the sperm donor’s medical history; however, Dr. Kiken did not respond.26 Ms. Richards contacted him again via phone and left a voicemail, but he did not call her back.27 During this time, Ms. Richards had her son’s DNA tested.28 The results showed that he and his sister were full siblings, and thereby confirmed that the same donor sperm was used to conceive both of them.29 A genealogist helped Ms. Richards’ daughter as she searched for information on her genetic history in different online databases.30 According to results from the database, Ancestry.com, Dr. Kiken was Ms. Richards’ children’s biological father and his parents were their biological grandparents.31 Ms. Richards’ children were also found to be genetically related to Dr. Kiken’s cousins.32 According to what genealogists believe, “the centimorgans, which are the units in which DNA is measured and passed on, that are shared by Dr. Kiken and Ms. Richard match what a child of Dr. Kiken would be expected to have.” 37 Furthermore, Ms. Richards alleges that Dr. Kiken disregarded the conditions that she and her husband had set forth and broke his promise to fulfill those conditions by using his own sperm, without her knowledge or consent, to impregnate her.38 She alleges that he violated his fiduciary duty and oath as a physician by inserting his own sperm into her,39 and she maintains that she would not have agreed to use sperm from someone who carried the Tay Sachs gene.40 Furthermore, Ms. Richards alleges that as a result of Dr. Kiken’s repetitive transgressions, her trust and life have been crushed and she has suffered from physical symptoms, including severe and devastating anxiety and emotional pain.41 Ms. Richards’s maintains that at the time Dr. Kiken committed the transgressions, he was in a professional and commercial relationship with her and fraudulently and knowingly hid from her what he had done in order to avoid being held liable for his wrongdoings.42 Ms. Richards argues that because of Dr. Kiken’s fraud, concealment, and failure to disclose the truth even though he was in a doctor-patient relationship with her and had a duty to do so, “she did not know nor could she have known in the exercise of reasonable care” that Dr. Kiken used his own sperm to impregnate her twice without her permission.43 Therefore, Ms. Richards argues that her cause of action did not accrue until she learned what Dr. Kiken had done through her daughter’s investigation into the identity of the sperm donor.44 She also maintains that by refusing to acknowledge that he is the father of her children now, Dr. Kiken’s actions constitute ongoing fraud.45 She claims that Dr. Kiken’s conduct was “malicious, oppressive, despicable and/or in reckless disregard [of her] rights,” and that by “using the same sperm to inseminate women living in a small geographic area—where their children may interact without knowing their genetic relation to one another,”46 Dr. Kiken actions show that he recklessly disregards the rights of his patients, their children, and the community generally.”

Effective July 22, 2011, a new law in the state of Washington requires any donor of sperm or eggs to provide a medical history and identifying information to fertility clinics. It also allows donor‐conceived individuals to request this information from clinics once they reach the age of eighteen. This is a significant legislative milestone and a promising development in a country that has consistently shied away from regulating the infertility industry in any way. What do we as a society owe donor‐conceived individuals in terms of obtaining access to information about their genetic origins? This essay addresses just one of this set of issues: the regulatory changes required to address the medical interests of donor‐conceived individuals, regardless of whether a human right to know one's genetic origins is acknowledged.

Sperm donation in China is different from that in other countries due to cultural, social and political factors. This research presents the current status of sperm donation in Mainland China and highlights some problems. Between January 2003 and December 2009, 19 471 sperm donors were screened totally and 6467 donors （33.2%） were recruited. The primary reasons for non-recruitment were either inadequate semen parameters （55.0%） or positive results for sexually transmitted diseases （7.9%）. There were 327 （1.7%） qualified donors who withdrew from the program because of frustration related to failed semen parameters, participation merely for free medical tests or job transfer. A questionnaire investigating donor intention, as well as other concerns associated with sperm donation, was distributed to 516 potential donors. All potential donors indicated their primary motivation as altruism, while 90.9% mentioned monetary reward as a second motivating factor. Approximately 93.4% of donors expressed some apprehension about the risk of consanguineous mating and the protection of their identity. Over the past 7 years, 488 389 vials of donors＇ semen have been cryopreserved. In 36 438 artificial insemination with donor sperm （AID） cycles, the clinical pregnancy rate was 23.9% and the live birth rate was 16.6%, In 7148 in vitro fertilization cycles, the clinical pregnancy rate was 45.8% and the live birth rate was 35.2%. Human sperm banks have been strictly monitored to ensure that each sperm donor can only impregnate five women nationwide. There is still a large gap between the supply and demand for sperm donation which may be solved by updated guidelines.

Beyond the scientific progress in assisted reproductive technologies （ART）, it is necessary to discuss the ethical considerations behind these advances. Ethical issues concerning sperm donation have been considered and discussed by government and non-governmental agencies, the public, media and academic institutions in many countries. Recommendations and guidelines concerning sperm donation issues vary from country to country and between professional groups within countries. This paper attempts to present an overview of findings and reports from various agencies concerning the ethics of sperm donation. The following topics are considered： limiting the number of donor offspring; minimizing risk of infection and genetics from sperm donors; age requirements for sperm donors; and anonymity versus non-anonymity of sperm donors. The diversity of policies shows that each country has its unique set of guidelines tailored toward its own specific needs. Similarly, countries designing their own procedures and guidelines concerning reproductive medicine must tailor them toward their own needs and practical considerations. In Mainland China, the anonymous policy for sperm donation should still be carried out, and the number of donor offspring should be revaluated. ART procedures must be conducted in a way that is respectful of those involved. Ethical principles must respect the interests and welfare of persons who will be born as well as the health and psychosocial welfare of all participants, including sperm donors.

Sperm donors’ obligations are typically constrained to the immediate circumstances surrounding the donation and to its time frame. This paper makes the case for recognizing an ongoing ethical obligation that binds sperm donors to disclose, in a timely manner, meaningful genetic information to recipients and donor-conceived children. The paper delineates and conceptualizes the suggested (potentially reciprocal) duty and argues that it is not the genetic link between the donor and the donor-conceived child that binds donors by said duty, but rather social responsibility. Accordingly, an original perception of the donor as an obligated alien is suggested and developed. The main thesis of the paper is supported inter alia by a comparison between transmitting infectious diseases and passing faulty genes on to donor-conceived children. The paper also provides an in-depth analysis of the conflicting interests of the parties generated by such an obligation and proposes a model for embedding this ethical duty in a (legal) contractual framework.

Sperm donors commonly cite a fear of future demands for money from offspring as the reason they wish to remain anonymous. Said says that sperm banks should, however, keep the identities and medical histories of donors on record indefinitely. This information can be consulted in the future in matters relating to an offspring's health. Some doctors, though, suggest that just because allowing people to donate sperm anonymously increases donation levels doesn't mean it's the right policy. \"You are bypassing the ethical argument and going straight to the pragmatic argument,\" says Dr. Ian Mitchell, a professor of pediatrics and bioethics at the University of Calgary. As for the argument that sperm donors were promised anonymity and that the promise shouldn't be broken, [Juliet Guichon] says that offspring were not party to that agreement. These offspring are sometimes told they should be happy just to be alive, says Guichon. \"I could be alive because of rape,\" she says, repeating an argument she has heard donor-conceived people make, \"but that doesn't mean I condone rape.\"

The issue of genetic inheritance, and particularly the contradictory rights of donors, recipients and donor offspring as to the disclosure of donor identities, is ethically complicated. Donors, donor offspring and parents of donor offspring may appeal to individual rights for confidentiality or disclosure within legal systems based on liberal rights discourse. This paper explores the ethical issues of non-disclosure of genetic inheritance by contrasting two principle models used to articulate the problem—liberal and communitarian ethical models. It argues that whilst the latter provides a more constructive avenue to providing an ethics for donation than the competing and contradictory positions represented in a liberal rights approach, it raises issues of ethical judgement and authority that remain problematic. This ethical discussion is supported by a field study, funded by the Wellcome Trust, exploring the perceptions and experiences of recipients of donor sperm and their partners towards donor anonymity. The field study provides the empirical basis of an argument for making ethical judgements on the grounds of the community good rather than individual rights, that nevertheless recognises that both are inherently problematic.

The author explores the ethics of decision-making and confidentiality in donor insemination through the narrative of her experience having two children with a sperm donor who was later discovered to carry a gene for a serious heart disease, hypertrophic cardiomyopathy. Contrasting individualist and communitarian ethical models, she questions understandings of confidentiality that hamper the construction of a medical family tree, especially when prognosis and treatment depend on the larger familial profile of the disease. She also emphasises that for the patient family the discovery of biological family through the lens of transmitted illness leads to a shift in family identity that goes beyond the purely medical.