Is America Growing Less Tolerant on L.G.B.T.Q. Rights?

When my sister came out, there was an accordion trio on hand to perform the music of Sly and the Family Stone.

Debutantes in white dresses and boys with matching cummberbunds and bowties drank from the waters of a gurgling champagne fountain. The entire affair, staged in my parents’ old house in Devon, Pa., was an anachronism, to be sure — but as wingdings go, it was tons of fun. It was 1975.

When I came out, in 2002, there wasn’t any party. There were tense meetings with the affirmative action/equal opportunity officer at my place of work; there was a carefully worded statement sent to my colleagues explaining exactly what “transgender” was; there was a series of conversations with my friends, and my mother, and the people whom I loved best, many of whom — in spite of their brave pledges to stand by me — ended those conversations in tears.

That was then.

People who “come out” at debutante parties have been off my radar for a long time now, although apparently they’re still going strong in some quarters. As for L.G.B.T.Q. people, “coming out” has gotten safer in fits and starts, not only in the wake of the Obergefell decision but also in other ways: L.G.B.T.Q. people are now visible in a way that was inconceivable half a generation ago. Most of the people that I thought I had lost after my 2002 unveiling have, miraculously, been returned to me, the intervening years having brought not only forgiveness but also understanding. Since my coming out, our family has thrived, and in the wake of that progress, I have believed that just as the Rev. Dr. Martin Luther King Jr. predicted, the arc of the moral universe does indeed bend toward justice.

Until now.

Last week, GLAAD — the media advocacy group for L.G.B.T.Q. people (of which I was a national co-chairwoman from 2013 to 2017) — released the results of its latest “Accelerating Acceptance” survey at the World Economic Forum in Davos, Switzerland. While the biggest headlines from the forum focused on the fact that the president of the United States managed to get through an event on the world stage without shoving any prime ministers or calling anyone’s country an outhouse, the results of the poll, conducted by Harris, deserve attention as well. They are shocking.

For the first time since the poll began, support for L.G.B.T.Q. people has dropped, in all seven areas that the survey measured. They include “having an L.G.B.T. person at my place of worship” (24 percent of Americans are “very” or “somewhat” uncomfortable), seeing a same-sex couple holding hands (31 percent are uncomfortable) and “learning my child has an L.G.B.T. teacher at school” (37 percent are uncomfortable).

New York Times – by Jennifer Finney Boylan, January 29, 2018

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One Day Your Mind May Fade. At Least You’ll Have a Plan.

When Ann Vandervelde visited her primary care doctor in August, he had something new to show her.

Dr. Barak Gaster, an internist at the University of Washington School of Medicine, had spent three years working with specialists in geriatrics, neurology, palliative care and psychiatry to come up with a five-page document that he calls a dementia-specific advance directive.

In simple language, it maps out the effects of mild, moderate and severe dementia, and asks patients to specify which medical interventions they would want — and not want — at each phase of the illness.living will, health care proxy, medical power of attorney

“Patients stumble into the advanced stage of dementia before anyone identifies it and talks to them about what’s happening,” Dr. Gaster told me. “At what point, if ever, would they not want medical interventions to keep them alive longer? A lot of people have strong opinions about this, but it’s hard to figure out how to let them express them as the disease progresses.”

One of those with strong opinions, it happens, was Ms. Vandervelde, 71, an abstract painter in Seattle. Her father had died of dementia years before, in a nursing home after her mother could no longer care for him at home. Ms. Vandervelde had also spent time with dementia patients as a hospice volunteer.

Further, caring for her mother in her final year, Ms. Vandervelde had seen how family conflicts could flare over medical decisions. “I was not going to leave that choice to my children if I could spare them that,” she said.

So when Dr. Gaster explained his directive, “it just made so much sense,” Ms. Vandervelde said. “While I could make these decisions, why not make them? I filled it out right there.”

Like a growing number of Americans over age 60, she already had a standard advance directive, designating a decision-maker (her husband) to direct her medical care if she became incapacitated.

Not all experts are convinced another directive is needed. But as Dr. Gaster and his co-authors recently argued in the journal JAMA, the usual forms don’t provide much help with dementia.

“The standard advance directives tend to focus on things like a ‘permanent coma’ or a ‘persistent vegetative state,’” Dr. Gaster said. “Most of the time, they apply to a person with less than six months to live.”

Although it’s a terminal disease, dementia often intensifies slowly, over many years. The point at which dementia patients can no longer direct their own care isn’t predictable or obvious.

Moreover, patients’ goals and preferences might well change over time. In the early stage, life may remain enjoyable and rewarding despite memory problems or difficulties with daily tasks.

“They have potentially many years in which they wouldn’t want a directive that says ‘do not resuscitate,’” Dr. Gaster said. But if severe dementia leaves them bedridden, unresponsive and dependent, they might feel differently — yet no longer be able to say so.

New York Times – January 19, 2018 by Paula Span

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Why a patchwork of laws makes surrogacy more challenging in Atlantic Canada

On a wall in Terri Taylor’s home, opposite the window that looks onto the quiet Fredericton cul-de-sac on which generations of her family have grown up, there’s a series of family photos.

Some of them are pictures of her own children, ranging from their teen years to when they were toddlers.

Others feature twin baby girls, the much longed-for children of Iain and Haley, an Australian couple Taylor met through a surrogacy website.

Taylor isn’t related to the twins, Freya and Jenna — nor is she related to their parents.Canada

But she does consider them part of her family.

‘We grew our own family’

Taylor points to a picture of herself, her children, Haley and Iain, and the twins clustered together at the centre of the arrangement. This one is more than just another family photo — it’s also the outcome of her decision to become a surrogate.

“I didn’t just grow two babies, we grew our own family, so that centre one is a pretty good representation of that — my new and expanded family.”

In Canada, hundreds of women every year serve as surrogates for other people, and the number is increasing; when the Canadian Fertility and Andrology Society started collecting statistics in 2001, around 100 women a year were acting as gestational surrogates, meaning they had no genetic relationship to the babies they were carrying.

Now that figure stands at more than 500, but demand still far outstrips supply.

For Taylor, serving as a surrogate was an extension of the same drive to care for others that had characterized her personal and professional life.

“I was never going to be rich, I was never going to donate a wing to a children’s hospital, so this was a way for me to give back.”

By Moira Donovan, CBC News, January 7, 2018

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Let’s set the record straight: There’s nothing wrong with surrogacy

This past December, Arizona Congressman Trent Franks resigned from office after asking two aides to be pregnant through surrogacy for him and his wife, reportedly offering one aide $5 million in return. According to reports, the women were concerned the congressman wanted to impregnate them through sexual intercourse.

The story went viral, causing confusion and stigma about one of the most life-changing medical advancements in history: the ability for females with prohibitive medical conditions, gay male couples, and parents of all ages to have biological children through surrogacy.

When it comes to fertility care, misinformation runs rampant. As fertility doctors, we’d like to set the record straight.

Surrogate mother word cloud concept

Surrogacy does not involve sexual intercourse

There are two main types of surrogacy: traditional and gestational. Traditional surrogacy means the female carrying the pregnancy (the surrogate) is using her own eggs. Different methods such as placing sperm in a uterus to help with fertilization (called intra-uterine insemination, or IUI) can be used to inseminate her with sperm from a male, who is often the intended parent. In this case, the surrogate is the biological mother. Gestational surrogacy, on the other hand, is when an embryo, which has been created using someone else’s egg and sperm, is transferred to a surrogate. The female carrying the pregnancy (the surrogate) is not biologically related to the child she is carrying.

Traditional surrogacy involves the insemination of the surrogate with sperm. Gestational surrogacy involves the implantation of an embryo. Neither requires sexual intercourse.

Surrogacy costs average $150,000, not $5 million

While pricey, surrogacy costs nothing close to the reported $5 million Congressman Franks offered his staffer. The average cost of surrogacy ranges from $100,000 to $200,000, depending on the fertility clinic used, number of IVF rounds, prenatal care, travel expenses, compensation for the surrogate, and additional medical and legal fees. These costs are mostly out-of-pocket and are prohibitively expensive for many people.

Facebook and Apple offer world-class fertility benefits that include surrogacy packages, but the tech firm juggernauts are in the minority. Most companies do not offer comprehensive fertility benefits that provide equal access to all employees. Unfortunately, far too many people still have to take out loans, borrow money from friends and family, raise money on crowdfunding sites, or forgo surrogacy altogether because of the high price point.

Surrogates undergo strict screening

It’s not easy to become a surrogate. Candidates go through a strict medical evaluation process before being approved as a carrier, including psychological screening, genetic screening, STD testing, and evaluations with reproductive specialists and a therapist. The American Society of Reproductive Medicine has recommended guidelines for gestational surrogates. 

Being approved is just the first step. As the surrogate prepares for an embryo transfer, she may take hormones daily. For gestational surrogacy, the intended mother or egg donor takes injectable medications to aid in retrieving eggs that will be fertilized to become embryos. The embryo is then ready to be transferred to a surrogate. And of course, once pregnant, surrogates attend routine prenatal visits and take on the burden of any pregnancy-related complications. 

Surrogacy is widely legal, but laws do vary

The legal landscape around surrogacy is often confusing, with laws varying between states and constantly changing. Though it’s widely regulated and legal throughout the majority of the country, most people are surprised to learn surrogacy is still illegal in some places in the United States Unfortunately, the complicated legal landscape can make access to this important aspect of fertility care more difficult.

TheHill.com, January 3, 2018 BY DR. ASIMA AHMAD AND DR. AMANDA ADELEYE

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Lesbian couples can now have children who are a part of each of them

Over the years I’ve had many lesbians tell me they want children but don’t see themselves being pregnant. It’s not part of their “body image.”

At some level, I understand this feeling. Our gender identity and sexual identity are tied up in our body image and feelings of sexual desire. Being pregnant and carrying a baby inside is an incredibly unique, womanly experience. Men have no idea what this is like, despite how much some may try.

As an experienced obstetrician who’s cared for many pregnant women throughout their pregnancies and deliveries, and as a gynecologist who has cared for and has performed gynecologic surgeries for women for the past thirty years, I’ve seen first-hand the many phases of reproductive health (and experiences with ill health) that only women can experience.IVF

I understand that some women may not identify with parts of that spectrum. For a lesbian couple it is sometimes easy to decide who will carry the pregnancy, while other couples struggle mightily with this uniquely lesbian decision. For single lesbian women, the choice can become more complex: to carry oneself and maybe go into new self-awareness territory, or to utilize the reproductive assistance of a gestational carrier.

We usually reserve gestational surrogates for women with a clearly defined medical need for surrogacy, yet lesbian women can often have very real issues that educate their life choices. Is body image a medical necessity for surrogacy? I believe that it can be if it’s tied into a woman’s sexual identity and sense of self.

We are very fortunate to live in a country where reproductive options are now available for all individuals regardless of gender, sexual identity, or marital status. This is not the case across Europe and other parts of the world. In my practice I see many patients from across the globe – from China, Europe and elsewhere – who travel for reproductive treatment options that are illegal where they live.

All women, and in particular lesbians, who might consider having children someday should talk with their doctor about reproductive options available, or ask for a referral to a fertility specialist to review the treatments that may best apply to their situation. It is imperative that lesbian women seek out a practice that is comfortable providing care to lesbians and same-sex couples.

By Dr. Guy Ringler, LGBTQNation.com – September 12, 2017

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TIAA adds LGBT benefit to help female couples with family planning

Investment advisory firm TIAA has added reciprocal IVF assistance to its family planning benefits package as an LGBT inclusion measure.

The New York City-based firm officially added the benefit July 1 after conversations with its LGBT employee resource group during Pride Month in June.

“The addition of reciprocal IVF [meaning one partner supplies the eggs to be used for IVF, while the other partner is the gestational carrier of the pregnancy] could significantly help female couples achieve their family planning goals, and we want to provide them with the same support other employees already receive,” says Skip Spriggs, senior executive vice president and chief human resources officer at TIAA. “It wasn’t a cost issue, but it was about creating the right environment.”TIAA

Prior to this benefits addition, employees had to go through a pre-certification process with a claims administrator to verify infertility, says TIAA. Now, employees can have IVF services covered without verifying that they tried natural or artificial insemination. Similarly, female couples don’t have to provide infertility to gain access to IVF as a covered benefit, the firm says.

Only 57% of employers offer a type of infertility service coverage, and 25% of the employers cover IVF, according to Mercer’s 2016 “National Survey of Employer-Sponsored Health Plans.”

by Amanda Eisenberg, August 21, 2017 – benefit news.com

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In Breakthrough, Scientists Edit a Dangerous Mutation From Genes in Human Embryos

Scientists for the first time have successfully edited genes in human embryos to repair a common and serious disease-causing mutation, producing apparently healthy embryos, according to a study published on Wednesday.

The research marks a major milestone and, while a long way from clinical use, it raises the prospect that gene editing may one day protect babies from a variety of hereditary conditions.

But the achievement is also an example of genetic engineering, once feared and unthinkable, and is sure to renew ethical concerns that some might try to design babies with certain traits, like greater intelligence or athleticism.

The study, published in the journal Nature, comes just months after a national scientific committee recommended new guidelines for modifying embryos, easing blanket proscriptions but urging it be used only for dire medical problems.

“We’ve always said in the past gene editing shouldn’t be done, mostly because it couldn’t be done safely,” said Richard Hynes, a cancer researcher at the Massachusetts Institute of Technology who co-led the committee. “That’s still true, but now it looks like it’s going to be done safely soon,” he said, adding that the research is “a big breakthrough.”

“What our report said was, once the technical hurdles are cleared, then there will be societal issues that have to be considered and discussions that are going to have to happen. Now’s the time.”

Scientists at Oregon Health and Science University, with colleagues in California, China and South Korea, reported that they repaired dozens of embryos, fixing a mutation that causes a common heart condition that can lead to sudden death later in life.

If embryos with the repaired mutation were allowed to develop into babies, they would not only be disease-free but also would not transmit the disease to descendants.

The researchers averted two important safety problems: They produced embryos in which all cells — not just some — were mutation-free, and they avoided creating unwanted extra mutations.

“It feels a bit like a ‘one small step for (hu)mans, one giant leap for (hu)mankind’ moment,” Jennifer Doudna, a biochemist who helped discover the gene-editing method used, called CRISPR-Cas9, said in an email.

“I expect these results will be encouraging to those who hope to use human embryo editing for either research or eventual clinical purposes,” said Dr. Doudna, who was not involved in the study.

New York times – August 2, 201 – by Pam Belluck

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Do kids think of sperm donors as family?

How do we define a parent — or a family?

Bioethicist Veerle Provoost explores these questions in the context of non-traditional families, ones brought together by adoption, second marriages, surrogate mothers and sperm donations. In this talk, she shares stories of how parents and children create their own family narratives.veerle-p

Click here to watch the Ted Talk.

Conscious Surrogacy – Making the Best Decisions For Your Family

Is there such a thing as conscious surrogacy? Yes, and those considering surrogacy will be confronted with some serious ethical questions.

Conscious surrogacy is a process. It is critical to understand some of the questions, and dilemmas, that you will face if you choose surrogacy to help you have your family.  If you are prepared to answer these questions before your surrogacy journey, and if you are comfortable with your answers, then you are ready to have these conversations with a potential surrogate mother.

What are some of the questions that you will face on your conscious surrogacy journey?

Do I want a single embryo or double embryo transfer? Do I want twins?  One of the first questions you will have to consider is whether you want to try and have twins with your surrogate mother.  Many choose this option for economic reasons.  If you know that you want more than one child, consecutive surrogacy journeys may not be an option.  But there is much more to consider.

conscious surrogacy

Twin pregnancies are much harder on the surrogate mother.  It can mean doctor ordered bed rest for your surrogate and more doctors’ visits, particularly in the third trimester.  Twin pregnancies also bring a higher risk of complications for the surrogate, such as preterm labor, and hypertension.

Twins arrive earlier. A normal singleton pregnancy is 40 weeks.  Most twins arrive early, at or before 36 weeks, which means that one or both of the children may require an extended hospital stay in the NICU (neonatal intensive care unit.)  Some doctors state that in 50% of twin pregnancies, a NICU stay is required.  This by itself may give parents pause about choosing a double embryo transfer.  Studies show that consecutive singleton births result in better medical outcomes than a single twin birth.  With all the information, you can make a conscious decision.

Do I want PGD or PGS? Preimplantation genetic diagnosis or screening is now being offered by most IVF facilities.  PGD or PGS allows a parent to view the genetic material of their child before an embryo is implanted in a surrogate mother’s womb.  PGD/S can show whether a child has any genetic disorders, the sex of the child and other genetic traits that may complicate a pregnancy.  While infertile couples who use IVF (in vitro fertilization), or anyone with a preexisting genetic condition,  may be familiar with PGD/S, couples or individuals who have their families with the assistance of a surrogate mother will most definitely be asked whether they want the information that PGD/S provides.

Knowing whether there is a genetic complication prior to embryo implantation may be in the best interests of all parties, however, choosing the sex of your child before it is born ventures into an ethical quagmire. Most families do not have this information and, while the technology exists, you must ask whether you want the information that it can provide.  The mental and physical health of your surrogate mother must be a priority in making this decision.

Do I want to selectively reduce if complications arise? Perhaps the most important questions you will confront is whether or not to selectively reduce, or abort, an embryo or fetus if there is a danger to the surrogate mother or to the child.  In reality, no state will enforce a gestational carrier contract which requires selective reduction.  The surrogate mother will always have the final say.  But you must know what you want first before you can discuss it with your surrogate.

While abortion is one of the most controversial topics in American society, it is routinely a part of conversations that intended parents have with their surrogate mothers. Surrogacy agreements attempt to cover all possible outcomes and obstacles that can arise during a surrogate pregnancy.  The most important aspect of this topic is being able to communicate your beliefs and desires with your surrogate.

There are many more issues that intended parents will face. Conscious surrogacy is about understanding the major decisions surrounding these issues and being able to come to a place of peace with each one, first with yourself, then with your surrogate mother.  Respecting her autonomy during the pregnancy will take you a long way toward reaching this goal.  Maintaining open and honest communication with your surrogate mother will also help to ensure that the journey is successful for all involved.

For more information about surrogacy, please visit http://www.timeforfamilies.com or email me at Anthony@timeforfamilies.com.

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New standards will tighten rules governing sperm and egg banks in Canada

Rigorous screening requirements would apply to those who donate sperm and eggs within Canada as well as abroad, when intended for export to Canada.

 

Sperm and egg banks will be required to review donors’ medical records and conduct more genetic testing under proposed new Canadian standards for assisted reproduction, which will be unveiled within two weeks, the Star has learned.

Developed by the Canadian Standards Association at the request of Health Canada, the new draft standards are intended to bring the country’s woefully outdated regulatory framework around assisted reproduction into the 21st century, says Dr. Arthur Leader, chair of a CSA subcommittee on assisted reproduction.Human Sperm Cell

Rigorous screening requirements would apply to those who donate sperm and eggs within Canada as well as abroad, when intended for export to Canada. Most donated sperm and eggs used in Canada comes from abroad.

Had these improvements already been in place, it’s unlikely the sperm of a U.S. man who turned out to have been diagnosed with a number of serious mental illnesses, including schizophrenia, would have made its way across the border, Leader says.

“If there had been a validated medical record, they would have caught this case,” he said.

Chris Aggeles had been advertised by Georgia-based sperm bank Xytex Corp. as exceptionally healthy, based on a medical history questionnaire he had filled out. His sperm was subsequently used in the creation of at least 36 children in Canada, the United States and Britain.

But the truth about his health was revealed only after Xytex mistakenly released his name to some mothers in an email. Until then, he had been anonymous.

Angie Collins, a Port Hope, Ont., woman who is mother to a nine-year-old boy created from Aggeles’ sperm, is thrilled about the proposed changes, particularly the requirement for sperm banks to check donors’ medical questionnaire against their health records.

Collins is one of a number of mothers who is suing Xytex.

“Until now, the honour system has been the relied-upon method and it is clearly ineffective. This would help to prevent situations like ours from arising. Parents would not have to spend years wondering if their child will or will not inherit the donor’s known debilitating mental health conditions,” she said.

The CSA’s new draft standards are intended to underpin improvements to the regulatory framework of assisted human reproduction legislation. They are being released for public commentary.

“Suggestions are most welcome because we want the best standards in the world. The hope is that Health Canada will reference these standards in their entirely in their regulations,” Leader said.

The news of the pending release of the draft standards comes a week after Health Canada announced plans to strengthen and clarify the regulations in the Assisted Human Reproduction Act.

Canada’s current semen regulations are focused primarily around screening donor sperm for sexually transmitted infections such as HIV, Hepatitis B and C and gonorrhea.

There exist no regulations for donor eggs or donor embryos.

TheStar.com by Theresa Boyle – 10/7/2016

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