To determine the attitudes of potential providers (general practitioners and Community Health Service workers) towards preconceptional cystic fibrosis (CF) carrier screening and to determine which factors are associated with a positive attitude. A survey was conducted among 200 general practitioners (GPs) and 134 Community Health Service (CHS) workers. Fifty-two percent of the eligible GPs participated and 84% of the CHS workers. Fifty-five percent of the GPs and 73% of the CHS workers had a positive attitude towards routinely offering CF carrier screening, and more than 80% were in favor of informing the target population about the possibility of having a CF carrier test. A positive attitude was associated with (a) high perceived severity of CF (b) religion (nonreligious compared to Reformed), (c) low perceived barriers, and (d) high perceived test reliability. The care providers who are most likely to be involved in a preconceptional CF carrier screening program, i.e. GPs and CHS workers, generally have a positive attitude towards the implementation of such a program.

Genetic testing in minor children presents a complex ethical and social problem. Current guidelines state that genetic testing of children is recommended only under circumstances where a clear medical or psychosocial benefit to the child can be demonstrated. Because of the difficulty in determining a psychosocial benefit, the discussion about genetic testing of minors ultimately tends to focus on who has the right to make the decision and whose right to autonomy is jeopardized, the parent\'s or the child\'s, when there is no identified medical benefit. Historically, a western bioethics paradigm, Principlism, has been used to guide genetic counseling sessions and genetic-testing guidelines for minors. This bioethics paradigm is guided by the principles: respect for autonomy, beneficence, nonmaleficence, and justice. Genetic testing in children, when viewed through a traditional bioethics filter is limited by its focus on the individual because children are not only individuals, they are also integral parts of a larger social context, that of their family. Because this bioethics paradigm places a strong emphasis on individual autonomy, the family\'s beliefs and values and the parents\' concern for their children may be overshadowed by the medical community\'s attempt to preserve the child\'s \"right\" to an autonomous decision about genetic testing. The purpose of this paper is to first discuss the circumstances in which genetic testing of minors occurs and then present a theoretical and ethics-based conceptual framework that may be useful in the development of genetic counseling interventions.

Court Decision: 756 North Eastern Reporter, 2d Series 1133; 2001 Oct 12 (date of decision). The Supreme Judicial Court of Massachusetts ordered the defendant hospital to designate the plaintiffs as parents on the birth certificates of their genetic children, delivered at the defendant hospital by a gestational carrier. Steven and Marla Culliton entered into a gestational surrogacy agreement with Melissa Carroll to have embryos which were created by in vitro fertilization with the plaintiffs\' own sperm and ova, implanted in the carrier. Before the children\'s births the plaintiffs requested a declaration of paternity and maternity and an order directing the hospital to enter the plaintiffs\' names in the children\'s birth certificates. The Family Court dismissed the complaint, citing lack of authority to issue any prebirth order of parentage. On appeal, the Supreme Judicial Court held that the Family Court had the authority to consider the complaint because the plaintiffs were the only genetic sources of the children, and neither party contested the complaint. Because the children were born while the case was on appeal, the Supreme Judicial Court entered judgment for the plaintiffs and ordered that they be listed as the mother and father of the children on their birth records. The Supreme Judicial Court also held that the defendant hospital was still required to supply the state Department of Health with confidential information regarding the identity of the woman who delivered the children and \"her prenatal health, labor and delivery, and postpartum care and condition\" under the hospital\'s duties and responsibilities to report vital records information for research and public health purposes.

Court Decision: 66 Pennsylvania District and County Reports, 4th Series 1; 2004 Apr 2 (date of decision). The Court of Common Pleas of Erie County, Pennsylvania held that a gestational surrogacy contract that failed to identify the legal mother of the children and allowed parties to bargain away the children\'s custody and support rights was void and against public policy. Plaintiff J.F. arranged to have his sperm fertilize a donor egg and to have the resulting fertilized egg implanted in defendant D.B., a gestational surrogate. After D.B. gave birth to slightly premature triplets, J.F. and his paramour showed only sporadic interest in the babies. Alarmed, D.B. took the triplets home and cared for them. J.F. sought sole custody of the triplets. The court granted temporary custody to D.B., but allowed J.F. and his paramour visitation rights. The court declared D.B. the legal mother of the children, even though she was not genetically related to the triplets, because she carried, bore, and took care of the children as a natural parent would. D.B.\'s actions were more in line with the behavior of a natural parent than J.F.\'s sporadic interest and haphazard visitation. D.B, as the legal mother, thereby had standing to pursue custody, and J.F., as the full biological father, had a legal duty to provide child support.

Court Decision: 376 Federal Reporter, 3d Series 908; 2004 July 16 (date of decision). The U.S. Court of Appeals for the Ninth Circuit reversed a lower court decision and held that Idaho\'s parental consent to abortion law was unconstitutional because it did not include a constitutionally valid medical emergency provision. Idaho\'s parental consent law contained an exception which allowed a minor to obtain an abortion without parental consent or a court order if the minor had a sudden, unexpected, and abnormal medical condition which required an immediate abortion to save her life or prevent serious risk of permanent, substantial injury. The court first rejected the state\'s argument that \"sudden and unexpected\" referred to the moment of diagnosis because the words referred to a physical condition (not a diagnosis), the word \"diagnosis\" did not appear in the statute, and every diagnosis could be considered sudden and unexpected. The court also noted that even a normal pregnancy could trigger a need for an immediate abortion in some or most women. Moreover, the court found that the onset of the underlying condition of many medical problems is often different from the time of diagnosis. The court declined to disregard the words \"sudden,\" \"unexpected,\" and \"abnormal\" because the words were pivotal to the meaning of the statute and held that the plain meaning of the medical emergency restriction was unconstitutionally narrow and interfered with a woman\'s right to undergo an abortion if her health was threatened by continuing her pregnancy. Moreover, the court held that the state\'s reading of the statute was neither \"fairly possible\" nor \"readily apparent.\" The court also held that the emergency medical provision was unconstitutional because the time period in which a decision could be rendered for a judicial bypass was open-ended, the deadline for filing a notice of appeal was unspecified, and the timeframe for the Idaho appellate process was indeterminate. Accordingly, there was no way an Idaho physician could be reasonably certain that an emergency abortion must be performed. Furthermore, the court did not find a greater interest in involving a pregnant minor\'s family in an emergency abortion than in any other medical emergency requiring immediate treatment and saw no reason for singling out physicians in the former situation to criminal liability. Finally, the court held that the offending provisions could not be severed from the law because the unconstitutional portion of the law was indispensable to its operation as the Legislature intended. The remainder of the law could not stand on its own because any parental consent statute must have a medical emergency exception.

Court Decision: 85 Pacific Reporter, 3d Series 67; 2004 March 1 (date of decision). The California Supreme Court agreed with a lower court decision that the state\'s Women\'s Contraception Equity Act (WCEA) requires employers who provide prescription drug benefits in their health care insurance plans to include prescription contraception coverage. Catholic Charities of Sacramento challenged the constitutionality of the provision, specifically with regard to its right to the free exercise of religion. The court held that Catholic Charities was not entitled to an exemption as it did not meet the criteria of a \"religious employer\" as delineated in WCEA. Furthermore, WCEA \"served a compelling state interest in the elimination of ... gender discrimination in the provision of health benefits\"; had a \"secular legislative purpose\"; was valid and neutral; and neither advanced or inhibited religion.

Court Decision: 95 California Reporter, 2d Series 864; 18 May 2000 (date of decision). The Court of Appeal, Second District held that parents and their child, conceived with sperm from an anonymous donor, could compel the donor\'s deposition and production of documents in an effort to discover information relevant to their action against the sperm bank, California Cryobank, Inc. Cryobank sold Diane and Ronald Johnson sperm that it falsely claimed was fully tested and genetically screened. The sperm, from donor John Doe, genetically transmitted a kidney disease to the Johnson\'s child. The Johnsons sought information and a deposition from Doe in their action against Cryobank; Doe refused. The court first held that communications between Cryobank and Doe were not protected under the physician-patient privilege because Doe was not a patient and he visited Cryobank with the sole purpose of selling his sperm. The court also found that the agreement between Cryobank and the Johnsons did not preclude the disclosure of Doe\'s identity under all circumstances because such preclusion is against public policy. Under state law, parties are allowed to inspect insemination records under certain circumstances. To prevent inspection under all circumstances conflicts with a compelling state interest in the health and welfare of children. Finally, the court did not find its holding in violation of Doe\'s right of privacy because, although Doe\'s medical records are protected under the right of privacy, compelling state interests in relevant disclosure in court proceedings, seeking the truth in court proceedings, and ensuring full redress of those injured override Doe\'s interest. The court specified that Doe\'s identity need not be automatically disclosed, and suggested the trial court construct an order protecting Doe\'s identity as much as possible.

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Assisted reproductive technology has helped many childless couples. It has also raised questions about how appropriate the technology might be in different situations. How we understand parenthood is crucial in taking a stand on such scientific intervention. It is suggested that physicians should decide on offering artificial insemination, surrogacy and in-vitro fertilisation only after considering if the child will have good parents and if there will be legal complications from the use of the technology.

Stem cell research has captured the imagination of many, including the scientific and medical community. But the medical community received a wake-up call early this year when a well-known researcher publicly confessed to deception. While the core question relates to honesty and integrity, it is equally necessary to examine the system that made such deception possible.