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Medical Hope, Legal Pitfalls: Potential Legal Issues in the Emerging Field of Oncofertility

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Oncofertility

Part of the book series: Cancer Treatment and Research ((CTAR,volume 156))

Abstract

The United States annually spends over $200 billion on cancer treatment and research [1]. Over the past several decades, tremendous progress has been made in combating this disease. The 5-year survival rate for cancer has increased from 35% in 1950–1954 to 67% in 1996–2004. Moreover, over the last 40 years, survival rates for childhood cancer have risen from 20 to 81% [2]. However, the very success of new and improved therapies has created a host of problems that were not previously considered. One of the results of the increased rate of post-cancer survival is the commensurate desire of former cancer patients to return to healthy lives, which for many includes having children. Unfortunately, for many this desire is difficult to fulfill, because the medication that succeeded in battling cancer is also quite often toxic to the reproductive organs. Thus, many people are able to live longer lives, yet they feel that their lives are incomplete because they became infertile. Whereas in the past fertility was not even part of the discussion when deciding on the proper cancer treatment, now it is a top concern of many newly diagnosed cancer patients [3]. In response to this concern, medical researchers are investigating several approaches (many of which are described in this book) to preserve cancer patients’ reproductive options.

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Notes

  1. 1.

    The United States is a signatory to this Covenant, and has formally ratified it, though with some reservations. 138 Cong. Rec. S8068–71 (1992).

  2. 2.

    To be sure, the right to bear children is not an unfettered one. Some courts have held that the state may limit a person’s ability to reproduce in certain circumstances such as imprisonment or flagrant disregard toward child support obligations. See, e.g., Gerber v. Hickman, 291 F.3d 617 (9th Cir. 2002) (en banc) (holding that prison inmates lose their right to reproduce); State v. Oakley, 629 N.W.2d 200 (Wis. 2001) (upholding a condition of probation requiring a “dead beat” to avoid having another child).

  3. 3.

    See Also In re Marriage of Witten, 672 N.W.2d 768 (Iowa 2003); Litowitz v. Litowitz, 48 P.3d 261 (Wash. 2002); A.Z. v. B.Z., 725 N.E.2d 1051 (Mass. 2000).

  4. 4.

    John Robertson argued that procreative liberty includes a constitutional right to state enforcement of surrogacy agreements [5]. For a critique of Robertson’s position, see Roberts DE. Social Justice, Procreative Liberty and the Limits of Liberal Theory: Robertson’s Children of Choice. Law & Soc. Inquiry. 1995; 20:1005–21.

  5. 5.

    Two federal appellate courts have rejected the claim that health plans that exclude infertility treatments violate Title VII of the Civil Rights Act of 1964 or the Pregnancy Discrimination Act (Krauel v. Iowa Methodist Med. Cent., 95 F.3d 674 (8th Cir. 1996); Saks v. Franklin Covey Co., 316 F.3d 337 (2d Cir. 2003)) [21].

  6. 6.

    There are exceptions to this rule. Parents cannot refuse life-saving treatments, such as blood transfusions, and may not deprive their children of medical attention when such deprivation is tantamount to child abuse. However, with respect to routine procedures, the choice lies with the parents.

  7. 7.

    When there is room for a legitimate difference of opinion as to which treatment is best, the state defers to the parental choice. Parents are, however, precluded from choosing a treatment that has no identifiable benefits to the minor [37].

  8. 8.

    In some cases, male circumcision may be medically necessary, but those constitute a minority of all circumcisions performed in this country.

  9. 9.

    The statute provides that (subject to certain medical necessity exceptions) “whoever knowingly circumcises, excises, or infibulates the whole or any part of the labia majora or labia minora or clitoris of another person who has not attained the age of 18 years shall be fined under this title or imprisoned not more than 5 years, or both.” Note, however, that an adult can consent to this procedure for herself. This is in line with the general rule that an adult can consent to virtually any legal medical treatment or procedure. (Criminalization of Female Genital Mutilation Act, 18 U.S.C. § 116 (2000)).

  10. 10.

    Cal. Penal Code § 273.4; Del. Code Ann. tit. 11, § 780; 720 Ill. Comp. Stat. 5/12-34 (2002); Md. Code Ann., Healt–Gen. § 20-601; Minn. Stat. Ann. § 609.2245; N.Y. Penal Law § 130.85; N.D. Cent. Code § 12.1-36-01; R.I. Gen. Laws § 11-5-2(c)(3); Tenn. Code Ann. § 39-13-110; Wis. Stat. Ann. § 146.35.

  11. 11.

    However, studies on mice have resulted in live births. See Xu M, et al. Tissue-Engineered Follicles Produce Live, Fertile Offspring. Tissue Engineering. 2006; 12:2739–2746.

  12. 12.

    There is a very narrow exception for intra-family donations by minors when such a donation is necessary to save the life of another family member. Even blood donation by minors is limited.

  13. 13.

    Tissue cannot be donated for transplantation with cancer patients because the risk of cancer re-seeding is too high [83].

  14. 14.

    “Relatives” here is broadly defined to include blood relatives, relatives by marriage, and significant others who may not have been married to the decedent, but maintained a committed sexual relationship.

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Acknowledgments

This research was supported by the Oncofertility Consortium NIH 8UL1DE019587, 5RL1HD058296. This chapter is an abridgeo version of a law review article that previously appeared in 49 SANTA CLARA L. Rev. 673 (2009).

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Authors and Affiliations

  1. George Washington University School of Law, Washington, DC, USA

    Gregory Dolin

  2. Northwestern University School of Law, Chicago, IL, USA

    Dorothy E. Roberts

  3. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Lina M. Rodriguez & Teresa K. Woodruff

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  1. Gregory Dolin
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  2. Dorothy E. Roberts
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  4. Teresa K. Woodruff
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Correspondence to Gregory Dolin .

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Editors and Affiliations

  1. Northwestern University, Feinberg School of Medicine, Chicago, 60611-3015, Illinois, USA

    Teresa K. Woodruff

  2. Northwestern University, Feinberg School of Medicine, Chicago, 60611-3015, Illinois, USA

    Laurie Zoloth

  3. Northwestern University, Feinberg School of Medicine, Chicago, 60611-3015, Illinois, USA

    Lisa Campo-Engelstein

  4. Northwestern University, Feinberg School of Medicine, Chicago, 60611-3015, Illinois, USA

    Sarah Rodriguez

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Dolin, G., Roberts, D.E., Rodriguez, L.M., Woodruff, T.K. (2010). Medical Hope, Legal Pitfalls: Potential Legal Issues in the Emerging Field of Oncofertility. In: Woodruff, T., Zoloth, L., Campo-Engelstein, L., Rodriguez, S. (eds) Oncofertility. Cancer Treatment and Research, vol 156. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-6518-9_9

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