Going Solo: The Law and Ethics of Childbirth During the COVID-19 Pandemic

The COVID-19 pandemic has had devastating effects on women’s reproductive lives. Women’s access to both abortion and contraceptive care has been restricted in many states across the U.S. Yet, the coronavirus has put a strain on another aspect of women’s reproductive rights: childbirth. In New York, for example, several hospitals instituted bans on all visitors in order to protect obstetric health care providers, as well as patients and newborn babies, from the risks posed by the virus. The policies were met with anger and confusion among expectant parents. An executive order issued in response to such criticism, overruling these policies, was described by some health professionals as unethical and ill-informed. Against this background this Essay maps the ethical and legal issues raised by childbirth visitation bans. It argues that the benefits of such visitation bans should be weighed against the implications they may have on laboring women’s emotional and physical well-being, considering the challenges they already face during facility-based childbirth. It then considers several national and international legal frameworks through which women’s birthing rights may be affirmed, also pointing out where they fall short. Lastly, this Essay makes recommendations for how such rights may be better addressed by different legal actors, including scholars, courts, and legislators

Reproductive Dreams and Nightmares: Sperm Donation in the Age of At-Home Genetic Testing

Recent technological developments surrounding genetic testing pose new challenges to well-established reproductive practices. One current example is the fertility industry’s struggle to maintain gamete donor anonymity against the growing use of direct-to-consumer DNA tests. Consider the widely covered story of Danielle Teuscher, who in 2019 accidentally discovered the identity of her daughter’s anonymous sperm donor after using a 23andMe DNA test. Danielle’s attempt to reach out to the newfound family member was followed by a cease and desist letter from the sperm bank for violating their agreement. In addition, the sperm bank refused to give Danielle the four vials of sperm from the same donor, which she had reserved for future use, thus thwarting her reproductive plans to have genetic siblings for her daughter. The Teuscher case introduces a type of reproductive dispute that United States courts have not yet resolved. This Article considers several of the new legal questions produced by this set of novel circumstances, about the legal framework through which the dispute should be adjudicated, the nature of the rights at stake, and the harms imposed by forced or confounded procreation. It argues that in the social context of anonymous sperm donation, the contractual approach is a more appropriate—if insufficient—legal prism through which a dispute over the use of donated sperm should be resolved. The context of sperm donation also demands a nuanced treatment of the rights at stake—one that distinguishes, for example, between the right not to be a genetic parent and the right not to be a parent in the legal sense. Furthermore, properly articulating the interests of the parties requires a reassessment of the harm that forced procreation will impose on a person who at least at some point in time agreed to father a child they would not know or care for, as well as the harm imposed on a person denied a child carrying a particular genetic constituency

Regulating Assisted Reproduction: Between Progress and Stagnation

This dissertation explores the increasingly complex legal challenges that the Israeli and American legal systems have faced with the development of assisted reproductive technologies (ART). It examines reproductive policies that prevail in both Israel and the U.S. that govern different utilizations of sperm, such as sperm donation, posthumous reproduction, and surrogacy, and the roles undertaken by—or assigned to—men in each reproductive context. Each chapter unpacks a set of questions arising at the intersection of such fundamental rights as autonomy, parenthood, bodily integrity, and equality in the ever-changing reproductive landscape. Together, they uncover how regulating reproduction shapes familial identities and institutions from legal and social standpoints while employing such critical theoretical lenses as feminism and masculinities. Chapter one, Securing Posterity: The Right to Posthumous Grandparenthood and the Problem for Law develops the normative discourse regarding posthumous reproduction, focusing on bereaved parents' reproductive interests. Practiced since the late 1980s, posthumous reproduction—the retrieval and use of gametes of deceased persons to produce a child following the death of at least one genetic parent—raises moral, ethical, and legal questions over its desired regulation. Over the past decade, a novel application of this form of ART has emerged: Bereaved parents began presenting to hospitals and courts requests to use their deceased son's reproductive gametes to produce a genetically related grandchild. Unlike the rights and interests of other expected stakeholders—the deceased, his spouse, and the future child—grandparental interests have yet to be articulated and analyzed. This chapter shows how the bereavement process that follows the loss of an adult child provides a valuable social context to understand parents' motivations in pursuing this reproductive route. It then argues that posthumous grandparenthood’s ability to provide comfort and relief amidst grief may also explain their relative success among judges and legislators. Notwithstanding the prevailing normative stance that views parents as having no ethical claim over their children’s gametes. This compassionate use of law raises, in turn, broad questions I discuss in this chapter about the role of law, its prescriptive nature, and its ability to address the legal challenges posed by such newly formed and imagined families. Chapter 2, Reproductive Dreams and Nightmares: Sperm Donation in the Age of At-Home Genetic Testing, explores a much less controversial use of ART: sperm donation. At its center is the widely covered story of Danielle Teuscher, who accidentally discovered the identity of her daughter’s anonymous sperm donor after using a 23andMe DNA test. Danielle’s attempt to reach out to the newfound family member was followed by a cease and desist letter from the sperm bank for violating their agreement. In addition, the sperm bank refused to give Danielle the four vials of sperm from the same donor, which she had reserved for future use, thus thwarting her reproductive plans to have genetic siblings for her daughter. Taking its cue from this case, this chapter shows how novel technological developments may challenge long-standing and well-established reproductive practices, illustrated by the fertility industry’s struggle to maintain gamete donor anonymity against the growing use of direct-to-consumer DNA tests. Using pre-embryo disposition disputes as a conceptual framework, it addresses the legal questions produced by this novel encounter between law and ART about the legal approach through which the dispute should be adjudicated, the nature of the rights at stake, and the harms imposed by forced or confounded procreation. It argues that in the social context of anonymous sperm donation, the contractual approach is a more appropriate—if insufficient—legal prism through which a dispute over the use of donated sperm should be resolved. Chapter 3, Men, Fatherhood, and the Regulation of Assisted Reproduction in Israel, develops the discourse surrounding men and reproductive law by examining how the law factors men into the regulation of assisted reproduction. Taking the Israeli legal landscape as an illustrative case study, it analyses policies that govern gamete donation, posthumous reproduction, and surrogacy. This analysis shows how this body of law underestimates men’s desire to rear—not just to sire—children by valorizing genetic lineage and treating their procreative stakes primarily as financial. In other instances, men’s access to principal routes to biological kinship is contingent upon the presence of a caregiving mother or otherwise denied. To understand the meaning of these findings, this chapter employs the critical lens of masculinities theory. It argues that the doctrinal patterns found in ART law correspond with masculine ideals underlying traditional perceptions of familial roles. The result is a narrow, stereotypical understanding of fatherhood as a relationship divested of nurture and care reflected in this body of law. This chapter concludes by arguing that recognizing men and women as equal stakeholders in these reproductive contexts is necessary, if insufficient, step toward a more egalitarian ART regime

Potential Protective Link Between Type I Diabetes and Parkinson's Disease Risk and Progression

BACKGROUND: Epidemiological studies suggested an association between Parkinson's disease (PD) and type 2 diabetes, but less is known about type 1 diabetes (T1D) and PD. OBJECTIVE: This study sought to explore the association between T1D and PD. METHODS: We used Mendelian randomization, linkage disequilibrium score regression, and multi-tissue transcriptome-wide analysis to examine the association between PD and T1D. RESULTS: Mendelian randomization showed a potentially protective role of T1D for PD risk (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.94-0.99; P = 0.039), as well as motor (OR, 0.94; 95% CI, 0.88-0.99; P = 0.044) and cognitive progression (OR, 1.50; 95% CI, 1.08-2.09; P = 0.015). We further found a negative genetic correlation between T1D and PD (rg = -0.17; P = 0.016), and we identified eight genes in cross-tissue transcriptome-wide analysis that were associated with both traits. CONCLUSIONS: Our results suggest a potential genetic link between T1D and PD risk and progression. Larger comprehensive epidemiological and genetic studies are required to validate our findings. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society

Clinical and Genetic Analysis of Costa Rican Patients With Parkinson's Disease

Background: Most research in genomics of Parkinson’s disease (PD) has been done in subjects of European ancestry, leading to sampling bias and leaving Latin American populations underrepresented. We sought to clinically characterize PD patients of Costa Rican origin and to sequence familial PD and atypical parkinsonism-associated genes in cases and controls. Methods: We enrolled 118 PD patients with 97 unrelated controls. Collected information included demographics, exposure to risk and protective factors, and motor and cognitive assessments. We sequenced coding and untranslated regions in familial PD and atypical parkinsonism-associated genes including GBA, SNCA, VPS35, LRRK2, GCH1, PRKN, PINK1, DJ-1, VPS13C, and ATP13A2. Results: Mean age of PD probands was 62.12 ± 13.51 years; 57.6% were male. The frequency of risk and protective factors averaged ∼45%. Physical activity significantly correlated with better motor performance despite years of disease. Increased years of education were significantly associated with better cognitive function, whereas hallucinations, falls, mood disorders, and coffee consumption correlated with worse cognitive performance. We did not identify an association between tested genes and PD or any damaging homozygous or compound heterozygous variants. Rare variants in LRRK2 were nominally associated with PD; six were located between amino acids p.1620 and 1623 in the C-terminal-of-ROC (COR) domain of Lrrk2. Non-synonymous GBA variants (p.T369M, p.N370S, and p.L444P) were identified in three healthy individuals. One PD patient carried a pathogenic GCH1 variant, p.K224R. Discussion: This is the first study that describes sociodemographics, risk factors, clinical presentation, and genetics of Costa Rican patients with PD, adding information to genomics research in a Latino population.Antecedentes: la mayor parte de la investigación en genómica de la enfermedad de Parkinson (EP) se ha realizado en sujetos de ascendencia europea, lo que provoca un sesgo de muestreo y deja a las poblaciones latinoamericanas infrarrepresentadas. Buscamos caracterizar clínicamente a los pacientes con EP de origen costarricense y secuenciar la EP familiar y los genes asociados con el parkinsonismo atípico en casos y controles. Métodos: Inscribimos a 118 pacientes con EP con 97 controles no relacionados. La información recopilada incluyó datos demográficos, exposición a factores de riesgo y de protección, y evaluaciones motoras y cognitivas. Se secuenciaron las regiones codificantes y no traducidas en la EP familiar y los genes asociados con el parkinsonismo atípico, incluidos GBA, SNCA, VPS35, LRRK2, GCH1, PRKN, PINK1, DJ-1, VPS13C y ATP13A2. Resultados: La edad media de los probandos de EP fue de 62,12 ± 13,51 años; El 57,6% eran hombres. La frecuencia de los factores de riesgo y protección promedió ~ 45%. La actividad física se correlacionó significativamente con un mejor rendimiento motor a pesar de años de enfermedad. El aumento de años de educación se asoció significativamente con una mejor función cognitiva, mientras que las alucinaciones, las caídas, los trastornos del estado de ánimo y el consumo de café se correlacionaron con un peor rendimiento cognitivo. No identificamos una asociación entre los genes probados y la EP ni ninguna variante heterocigótica homocigótica o compuesta dañina. Las variantes raras en LRRK2 se asociaron nominalmente con la EP; seis estaban ubicados entre los aminoácidos p.1620 y 1623 en el dominio C-terminal-de-ROC (COR) de Lrrk2. Se identificaron variantes de GBA no sinónimas (p.T369M, p.N370S y p.L444P) en tres individuos sanos. Un paciente con EP portaba una variante patógena de GCH1, p.K224R.Universidad de Costa Rica/[837-B5-304]/UCR/Costa RicaCanadian Consortium on Neurodegeneration in Aging/[]/CCNA/CanadáCanada First Research Excellence Fund/[]/CFREF/CanadáHealthy Brains for Healthy Lives/[]/HBHL/CanadáUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Centro de Investigación en Neurociencias (CIN)UCR::Vicerrectoría de Docencia::Salud::Facultad de Medicina::Escuela de Medicin

Heritability Enrichment Implicates Microglia in Parkinson's Disease Pathogenesis

Objective Understanding how different parts of the immune system contribute to pathogenesis in Parkinson's disease is a burning challenge with important therapeutic implications. We studied enrichment of common variant heritability for Parkinson's disease stratified by immune and brain cell types. Methods We used summary statistics from the most recent meta-analysis of genomewide association studies in Parkinson's disease and partitioned heritability using linkage disequilibrium score regression, stratified for specific cell types, as defined by open chromatin regions. We also validated enrichment results using a polygenic risk score approach and intersected disease-associated variants with epigenetic data and expression quantitative loci to nominate and explore a putative microglial locus. Results We found significant enrichment of Parkinson's disease risk heritability in open chromatin regions of microglia and monocytes. Genomic annotations overlapped substantially between these 2 cell types, and only the enrichment signal for microglia remained significant in a joint model. We present evidence suggesting P2RY12, a key microglial gene and target for the antithrombotic agent clopidogrel, as the likely driver of a significant Parkinson's disease association signal on chromosome 3. Interpretation Our results provide further support for the importance of immune mechanisms in Parkinson's disease pathogenesis, highlight microglial dysregulation as a contributing etiological factor, and nominate a targetable microglial gene candidate as a pathogenic player. Immune processes can be modulated by therapy, with potentially important clinical implications for future treatment in Parkinson's disease. ANN NEUROL 202

Heritability enrichment implicates microglia in Parkinson's disease pathogenesis

OBJECTIVE: Understanding how different parts of the immune system contribute to pathogenesis in Parkinson's disease is a burning challenge with important therapeutic implications. We studied enrichment of common variant heritability for Parkinson's disease stratified by immune and brain cell types. METHODS: We used summary statistics from the most recent meta-analysis of genome-wide association studies in Parkinson's disease and partitioned heritability using linkage disequilibrium score regression, stratified for specific cell types as defined by open chromatin regions. We also validated enrichment results using a polygenic risk score approach and intersected disease-associated variants with epigenetic data and expression quantitative loci to nominate and explore a putative microglial locus. RESULTS: We found significant enrichment of Parkinson's disease risk heritability in open chromatin regions of microglia and monocytes. Genomic annotations overlapped substantially between these two cell types, and only the enrichment signal for microglia remained significant in a joint model. We present evidence suggesting P2RY12, a key microglial gene and target for the anti-thrombotic agent clopidogrel, as the likely driver of a significant Parkinson's disease association signal on chromosome 3. INTERPRETATION: Our results provide further support for the importance of immune mechanisms in PD pathogenesis, highlight microglial dysregulation as a contributing etiological factor and nominate a targetable microglial gene candidate as a pathogenic player. Immune processes can be modulated by therapy, with potentially important clinical implications for future treatment in Parkinson's disease

Revisiting protein aggregation as pathogenic in sporadic Parkinson and Alzheimer diseases.

The gold standard for a definitive diagnosis of Parkinson disease (PD) is the pathologic finding of aggregated α-synuclein into Lewy bodies and for Alzheimer disease (AD) aggregated amyloid into plaques and hyperphosphorylated tau into tangles. Implicit in this clinicopathologic-based nosology is the assumption that pathologic protein aggregation at autopsy reflects pathogenesis at disease onset. While these aggregates may in exceptional cases be on a causal pathway in humans (e.g., aggregated α-synuclein in SNCA gene multiplication or aggregated β-amyloid in APP mutations), their near universality at postmortem in sporadic PD and AD suggests they may alternatively represent common outcomes from upstream mechanisms or compensatory responses to cellular stress in order to delay cell death. These 3 conceptual frameworks of protein aggregation (pathogenic, epiphenomenon, protective) are difficult to resolve because of the inability to probe brain tissue in real time. Whereas animal models, in which neither PD nor AD occur in natural states, consistently support a pathogenic role of protein aggregation, indirect evidence from human studies does not. We hypothesize that (1) current biomarkers of protein aggregates may be relevant to common pathology but not to subgroup pathogenesis and (2) disease-modifying treatments targeting oligomers or fibrils might be futile or deleterious because these proteins are epiphenomena or protective in the human brain under molecular stress. Future precision medicine efforts for molecular targeting of neurodegenerative diseases may require analyses not anchored on current clinicopathologic criteria but instead on biological signals generated from large deeply phenotyped aging populations or from smaller but well-defined genetic-molecular cohorts