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Introduction

Medical technologies that disassociate sexual intercourse from reproduction plunge physicians into the age-old maelstrom surrounding legitimacy, fidelity, and heritage. Except for introducing ambiguity into maternity as well as paternity, medical technology has transformed old problems more than it has created new ones. The transformation has been to substitute medical technology for sexual intercourse. The medicalization of reproduction allows the participants to escape from the religious and social opprobrium that defined acceptable reproductive choices. This disassociation from traditional religious values and legal rules poses grave ethical and legal questions about the use of certain reproductive technologies. The problems of adoption are better understood, but they have also been complicated by reproductive technologies that confuse the problem of determining whose parental rights control the adoption. This chapter presents a basic legal framework for analyzing the issues arising from reproductive technologies. Chapter 26 discusses the medical and ethical issues of surrogacy arrangements.

These issues are addressed within the traditional context of adoption and parental rights determinations. This leads to a conservative approach based on the stricter state laws in each area. While this provides a more generally applicable legal and ethical approach to reproductive technologies, physicians in less restrictive states may choose to be more aggressive in their use of these technologies, consistent with appropriate legal and ethical guidelines. Since legitimacy determinations and adoption laws differ dramatically from state to state, it is important for physicians to ensure that they comply with applicable state laws. Procedures that are legal and acceptable in one state may subject the physician to criminal prosecution and imprisonment in a different state.


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