Professional Documents
Culture Documents
Scientists have been able to help patients suffering from over 70 differ-
ent diseases and injuries—including brain cancer, leukemia, lymphoma,
Crone’s disease, Lupus, heart damage, Parkinson’s, Sickle cell anemia,
and end-stage bladder disease—using adult stem cells. Conversely, mor-
ally-problematic embryonic stem-cell research has not helped a single hu-
man patient.
ers. Moreover, research breakthroughs since The U.S. Supreme Court has never ruled on
2007 are opening the door for the reprogram- the legal status of a human embryo outside of
ming of adult stem cells into the embryonic the mother’s womb. In August 2001, Presi-
stem cell state—without the use or destruction dent George W. Bush announced that federal
of human embryos. funding would be allowed only for research
on then-existing embryonic stem-cell lines.
Adult stem cells have helped patients with over But in March 2009, President Barack Obama
70 different diseases, with more being continu- signed an Executive Order reversing that pol-
ally added. The future of human cures is not in icy. President Obama’s decision to fund such
destroying some humans to treat others. It is in destructive research—which runs counter to
ethical treatments that treat all human life with federal law under the Dickey-Weber amend-
dignity and respect. But proponents of embry- ment that prohibits research that will harm an
onic stem-cell research have purposely created embryo—was immediately challenged in fed-
a false impression eral court, but a Cir-
that embryonic stem cuit court has allowed
cells have a proven the funding to contin-
therapeutic use, when ue while the case is in
they have in reality litigation.
never helped a single
human patient. It is, therefore, up to
the states to institute
In addition to the facts protective measures.
that 1) it is necessary Currently, seven
to destroy nascent hu- states either expressly
man life to obtain em- or impliedly ban DER
bryonic stem cells for on embryos created
research, and 2) embryonic stem-cell research through in vitro fertilization (IVF) or cloned
has never helped a human patient, such re- human embryos, and 19 states ban fetal experi-
search is also immoral because the only way to mentation. In addition to these direct bans on
obtain the human eggs necessary to create em- research, at least six states restrict funding or
bryos is to exploit women. A woman normally the use of state facilities for DER, and 16 states
only produces one or two eggs per reproduc- have passed legislation encouraging the use of
tive cycle. To obtain enough eggs for research, adult stem cells or umbilical cord blood and/or
a woman must take drugs that will cause her to the donation of umbilical cord blood.
super-ovulate, releasing 10-15 eggs at a time,
and undergo an invasive surgical procedure in AUL has drafted several models to help states
order to retrieve them. Thus, it is simply not curb ineffective, unethical research and pro-
possible to obtain enough eggs from willing mote ethical research that is already making a
women to adequately pursue this research or difference. These models include the “Destruc-
treat possible diseases that may come from any tive Embryo Research Act” banning destruc-
breakthroughs using embryonic stem cells.3 tive embryo research; a “Prohibition on Public
Funding of Human Cloning and Destructive Both rationales are morally wrong because
Embryo Research Act”; and an “Egg Provider both scientifically begin with the creation of a
Protection Act,” focused on preventing the ex- cloned human being at the embryonic stage of
ploitation of women. life. The differing justifications that one clone
is destined to be destroyed for its stem cells
Human Cloning and the other for implantation in a womb do
not—and cannot—change the basic scientific
One of the inherent problems in using embry- fact that the cloned human embryos created
onic stem cells in therapies is the problem of for therapeutic or reproductive purposes are
transplantation. If a transplanted cell’s DNA simultaneously human beings. For this rea-
is even somewhat different from the DNA of son and others, comprehensive bans on human
the person being treated, the body usually sees cloning should be enacted in the 50 states and
those cells as invaders and kills them off— by the U.S. Congress.
much like what happens when whole-organ
transplants are rejected because of the recipi- Currently, no federal law bans human cloning
ent’s immune system response. Without the for any purpose, and the U.S. Supreme Court
use of drugs to suppress the patient’s immune has not yet spoken on the subject. However,
system, transplanted tissue generally survives seven states ban human cloning for any pur-
only a few hours or days. pose, while eight states ban cloning-to-pro-
duce-children. Five states have no laws ban-
To overcome this inherent problem, scientists ning human cloning, but do possess statutes
began pursuing human cloning as a method which may be interpreted as prohibiting harm-
for obtaining genetically-compatible cells for ful experimentation on IVF-created or cloned
transplantation. Human cloning is the process human embryos. Conversely, at least seven
through which an human egg is taken from states fund cloning or embryonic stem-cell re-
a woman, the nucleus is removed, and then search.
it is replaced with a nucleus from a patient’s
body cell. Using electrical shock or “chemical AUL has drafted a “Human Cloning Prohibi-
bath,” the egg is tricked into believing it has tion Act” to assist states seeking to ban human
been fertilized, and it begins to divide, becom- cloning for all purposes. And as previously
ing a human embryo. mentioned, AUL has also drafted a model bill
prohibiting the public funding of such unethi-
A general misconception exists that there are cal research.
two types of human cloning: therapeutic clon-
ing (or “cloning-for-biomedical-research”) and Assisted Reproductive Technologies (ART)
reproductive cloning (or “cloning-to-produce-
children”). However, these designations are In vitro fertilization (IVF) is the fertilization
simply two different rationales or justifications of a human egg by a human sperm outside a
offered for the same procedure, known medi- woman’s body, in a laboratory. The term “as-
cally as “somatic cell nuclear transfer,” or hu- sisted reproductive technology” (ART) encom-
man cloning. passes both IVF as well as other newer forms
of ART. Despite the increasingly wide-spread of state statutes directly concerned with assist-
use of these reproductive technologies, there ed reproduction … are concerned mostly with
is a lack of common-sense regulation of these the question of access to such services.”5 For
procedures at both the federal and state levels. example, at least 14 states address insurance
This lack of regulation has resulted in the stor- coverage of ART.
age of more than 400,000 cryopreserved (fro-
zen) human embryos in laboratories across the Meanwhile, a small number of states have vari-
United States. ous provisions providing that only physicians
may perform ART, placing
In 2004, the President’s limits on assisted insemina-
Council on Bioethics issued tion procedures, defining the
a report, Reproduction & legal status of the child creat-
Responsibility, outlining the ed by ART, defining the legal
lack of regulation of ART. As status of the parent or donor,
the Council’s report points regulating the use of public
out, “[t]here is only one fed- funds or facilities for ART,
eral statute that aims at the mandating informed consent
regulation of assisted repro- for ART, or governing the
duction: the ‘Fertility Clinic treatment of human embryos.
Success Rate and Certifica-
tion Act of 1992’ (sometimes called the ‘Wyden Responsible state and federal regulation is nec-
Act’),” and it only serves two purposes: 1) pro- essary for several reasons:
viding consumers with information about the
effectiveness of ART services, and 2) provid- • Assisted reproductive technologies,
ing states with a model certification process for primarily IVF, are the gateway to all
embryo laboratories.4 Additionally, the “Clin- future genetic engineering. The cur-
ic Laboratory Improvement Amendments of rent lack of regulation promotes the
1988” govern quality assurance and control in creation and destruction of excess em-
clinical laboratories including those involved bryos and, if not adequately responded
in ART, and the Centers for Disease Control to, promotes conditions conducive for
and Prevention (CDC) has announced a new human cloning and other immoral ex-
national ART Surveillance System. These reg- perimentation on human life in its ear-
ulations pale in comparison to those in place in liest forms.
Great Britain, Germany, Sweden, Switzerland,
and many other European nations, where, for • The health of women undergoing IVF,
example, the number of embryos transferred who are often injected with hormones
per reproductive cycle is limited by law. that may cause cancer and other dis-
eases, may be compromised, and sub-
The Council’s March 2004 report further con- sequently-born children may suffer
firmed that ART is little regulated by the states. genetic damage from the procedures.
In fact, as the report noted, “[t]he vast majority
• There are increasing numbers of mul- gan donation, and the possibility of a relation-
tiple births (with associated health and ship with the placing family. Programs such
safety concerns), as well as the use as the Snowflake Embryo Adoption Program
of so-called selective reductions (i.e., require adopting couples to undergo extensive
abortions) of unborn children. screening, such as fingerprinting, background
checks, home studies, infant CPR, and par-
AUL has drafted model legislation, entitled the enting classes. Placing families and adoptive
“Assisted Reproductive Technologies Disclo- families prepare informational portfolios about
sure and Risk Reduction Act,” aimed at ensur- themselves—dossiers including everything
ing truly informed consent by couples under- from photographs to information regarding
going ART processes as well as regulating the religious backgrounds. Like birth mothers,
number of embryos that can be transferred in a genetic parents use this information to choose
single reproductive cycle. adoptive parents to bear and raise their em-
bryos.
Embryo Adoption
Currently, however, embryos are usually
The lack of ART regulation has left hundreds stranded in a sort of legal no man’s-land. Many
of thousands of embryos frozen in time. But courts are reluctant to classify embryos as prop-
through embryo adoption, couples can adopt erty, but they also do not characterize them as
so-called leftover embryos from other couples human beings. Laws regarding embryo dona-
who have already undergone IVF. This pro- tion and adoption are, at best, unsettled. There
cess represents an emerging alternative to the are no federal laws which specifically address
traditional options left to IVF parents: indefi- these issues, but three states have provided
nite cryopreservation, donation to anonymous general guidance for embryo donation and al-
persons, or donation for research. low for embryo adoption.
Not only does embryo adoption allow parents AUL has crafted a model bill, entitled the
to choose an alternative other than destruction “Embryo Adoption Act,” for states interested
for research, but it also offers a more attractive in explicitly permitting embryo adoption and
option than donation. When the embryos are bringing it under the auspices of their existing
donated to other couples, as opposed to adopt- adoption laws.
ed by them, the process is anonymous and the
placement is usually determined by the fertility Genetic Testing and Discrimination
clinic’s physician. Receiving couples usually
undergo only basic medical screening and psy- Genetic testing is currently available for 1,500
chological counseling. diseases, and tests for hundreds of others are
currently being developed.6 But, as with other
When embryos are adopted, on the other hand, areas of biotechnological success, ethical is-
the process is typically much more open. The sues have arisen with the advancement of ge-
adopting family will likely have access to the netic testing. For example, can health insur-
child’s history, a potential match for future or- ance companies use the results of genetic test-
sulting in the destruction of the cloned ment. This naturally happens in the
human being. organized human embryo, but is some-
thing that scientists have yet to learn
• Cloning-to-produce-children—the how to control. The primary ethi-
creation of a new human being at the cal issues associated with using these
embryonic stage of life genetically cells are that they currently require the
identical to a single parent, with the destruction of a living human embryo
intention that the cloned human be- and that use of such cells in medical
ing will be implanted in a womb and research constitutes unethical experi-
born. mentation when there has not been ad-
equate research using animals. Some-
• Cord blood stem cell—an adult stem times referred to as “pluripotent stem
cell found in the umbilical cord blood cells,” there is not a single disease that
of newborn infants. Umbilical cords, physicians can treat with these cells.
which are routinely discarded, were
discovered to have an unusually high • Genetic discrimination—discrimina-
concentration of adult stem cells which tion which “occurs if people are treat-
are very easy to obtain and are capable ed unfairly because of differences in
of treating a host of diseases. In 2006, their DNA that increase their chances
Congress passed legislation that will of getting a certain disease. For ex-
create a national umbilical cord blood ample, a health insurer might refuse to
bank similar to the national bone mar- give coverage to a woman who has a
row system for the public. DNA difference that raises her odds of
getting breast cancer. Employers also
• Embryo—an entity that, through could use DNA information to decide
whatever means (normal reproduc- whether to hire or fire workers.”7
tion, cloning, or other method), has a
full complement of DNA and, with the • Genetic testing—testing “developed
proper environment and nutrition and to find DNA differences that affect
unless otherwise interrupted, will de- our health.”8 In other words, these are
velop along the natural course of pro- tests which “look for alterations in a
gression for that species into further person’s genes or changes in the level
stages of development until natural of key proteins coded for by specific
death. genes.”9 It is believed that healthcare
providers will be able to utilize “infor-
• Embryonic stem cell—an early-stage mation about each person’s DNA to
stem cell obtained by destroying em- develop more individualized ways of
bryos of the same species. Embry- detecting, treating and preventing dis-
onic stem cells can become virtually ease.”10
any type of cell in the body, but only
if properly directed in their develop- • Somatic cell nuclear transfer
(SCNT)—a type of cloning. A pro- cal justification for destroying nascent human
cess in which the nucleus (and there- life regardless of its origins. It is never right to
fore the original DNA) is removed intentionally kill innocent human life to save
from an egg and discarded, the nucleus another’s life, especially in such a systematic
of a somatic (or body) cell containing manner.
the genetic material of another entity is Myth: Cloned human embryos are not really
transplanted into the egg, and an elec- human.
tric shock or chemical solution is used Fact: This would mean that Dolly, the first
to trick the egg into believing it has mammal clone, was not a sheep, despite the
been fertilized. The egg, containing fact she was created using a sheep egg and
another entity’s DNA, begins dividing sheep DNA and after birth looked and acted
as any other early embryo. like a sheep. If cloned human embryos are not
human, then what are they? The only logical
• Zygote—a one-cell embryo. From answer is that a cloned human embryo is fully
this one cell will arise every cell in human.
the body. Sometimes inaccurately re-
ferred to as a fertilized egg or “totipo- Myth: We do not owe a right to life to cloned
tent cell.” embryos. They are an unnatural aberration.
Fact: Regardless of the ethical issues sur-
MYTHS & FACTS rounding the creation of human clones or why
a clone was created, if created it should not be
Myth: Embryonic stem-cell researchers are forbidden to live. We do not require the de-
close to finding cures for a host of terrible dis- struction of human life when created through
eases, like cancer, diabetes, and neurological other unethical means (e.g., rape). Laws
disorders such as Parkinson’s. against creating cloned embryos should not re-
Fact: Embryonic stem cells are unable to cure quire the clone’s destruction.
anyone of anything. Instead, use of the cells in
humans does little good and can do great harm Myth: A ban on destructive human embryo
(through tumor formation). . Adult stem-cell research or human cloning will stifle scien-
research is helping cure or treat more than 70 tific research or economic development in my
diseases, with more work being prepared for or state.
currently in clinical trials. Fact: Few companies even do this research, in
part because there are no foreseeable cures that
Myth: Embryonic stem-cell research, includ- will recoup the dollars needed for investment.
ing the destruction of embryos for their parts, And, if embryonic stem-cell research ends up
is morally and ethically acceptable. not producing cures, companies may not sur-
Fact: Even if breakthroughs using embry- vive long enough to produce any benefit.
onic stem cells do occur, it is still unethical
to destroy human embryos for their “parts.” Myth: Embryos left over from in vitro fertil-
Regardless of the perceived or real benefit of ization (IVF) procedures are just going to die
destroying human embryos, there is no ethi- anyway. We should get some benefit from
part of insurance companies. Questions About Genetic Testing (February 5, 2009), available at
http://www.genome.gov/19516567 (last visited July 17, 2009).
10
National Human Genome Research Institute, Genetic Dis-
Myth: My state adequately protects me against crimination Fact Sheet: Genetic Information Nondiscrimination
genetic discrimination. Law of 2008, supra.
11
AUL Senior Vice President of Legal Affairs William Saunders
Fact: While at least 40 states and the District addresses the moral status of the human embryo in The Human
of Columbia prohibit discrimination in health Embryo in Debate, in HUMAN DIGNITY IN THE BIOTECH
CENTURY 115 (C.W. Colson & N. Cameron, eds. 2004).
insurance policies based upon the results of
genetic testing, the degree of protection dif-
fers. For example, some states specifically
prohibit health insurers from requiring testing,
while others allow health insurers to consider
the results of tests only if the patients volun-
tarily submit favorable results. On the other
hand, some states actually encourage genetic
testing or allow discrimination in certain types
of health insurance policies. Thus, states are
encouraged to enact further restrictions limit-
ing the use of genetic information by all insur-
ance companies.
Endnotes
1
Michael J. Schlambott et. al., Derivation of pluripotent stem
cells from cultured human primordial germ cells, Proc. Nat’l
Acad. Sci. USA 95:23, 13726-731 (1998).
2
See M. J. Evans & M. H. Kaufman, Establishment in culture
of pluripotential cells from mouse embryos, Nature 292, 154–56
(1981).
3
See David Prentice, Under the Microscope: A Scientific Look at
Cloning, Family Policy 15:3. See also Wesley J. Smith, Lessons
From the Cloning Debate: The Need for a Secular Approach,
in Human Dignity in the Biotech Century 194-96 (Charles W.
Colson & Nigel M. de S. Cameron, eds. 2004) (explaining that
it is not physiologically possible to obtain enough eggs to treat
disease through stem cell research and human cloning).
4
President’s Council on Bioethics, Reproduction & Responsibil-
ity (March 2004).
5
Id. at 51.
6
Genetic & Public Policy Center of Johns Hopkins University,
Genetic Privacy & Discrimination (updated March 2009), avail-
able at http://www.dnapolicy.org/policy.privacy.php (last visited
July 17, 2009).
7
National Human Genome Research Institute, Genetic Discrimi-
nation Fact Sheet: Genetic Information Nondiscrimination Law
of 2008 (updated January 9, 2009), available at http://www.ge-
nome.gov/10002328 (last visited July 17, 2009).
8
Id.
9
National Human Genome Research Institute, Frequently Asked
Eight states ban cloning for any purpose, including both cloning-to-produce-children
and cloning-for-biomedical-research: AR, AZ, IN, MI, ND, OK, SD, and VA
Eight states allow human cloning for destructive embryo research (cloning-for-
biomedical-research) but prohibit attempting to bring a cloned child to term (cloning-
to-produce-children): CA, CT, IL, IA, MA, MO, MT, and RI
Five states have no specific law on human cloning, but have statutes that either
expressly or implicitly ban destructive human embryo research on IVF-created
embryos and possibly on cloned human embryos: LA, ME, MN, NM, and PA
One state permits destructive experimentation on both cloned human embryos and
cloned human fetuses up to live birth: NJ.
Seven states use state tax dollars to fund destructive human embryo research:
CA, CT, IL, MD, MA, NJ, and WI.
Six states restrict funding or use of state facilities for human cloning and/or
destructive human embryo research: AZ, IN, KS, LA, MN, and NE.
One state restricts funding for human cloning and/or destructive embryo research
and prohibits loans for entities conducting destructive human embryo research,
but also allows tax incentives for destructive human embryo research by providing
that research equipment is not taxed: VA
At least 17 states promote or encourage the use of umbilical cord cells and/or
other forms of adult stem cells for research: AZ, CO, FL, GA, MD, MA, MO, NE,
NJ, NM, NY, NC, OH, OK, TN, TX, and VA.
Nineteen states continue to ban so-called fetal experimentation: FL, KY, LA, ME,
MA, MN, MT, NE, NM, ND, OH, OK, PA, RI, SD, TN, TX, UT, and WY. (However,
four federal courts have invalidated other states’ fetal experimentation laws.)
Only one state comprehensively regulates ART/IVF and facilities performing such
procedures: PA
At least five states regulate the donation and/or transfer of human sperm, human
eggs, or pre-embryos: CA, FL, ID, NY, and OK
Four states require some form of informed consent or impose specific contractual
requirements for ART/IVF: AR, CT, MA, and VA
At least five states regulate the types of healthcare providers that can perform
ART/IVF: AR, CT, ID, NH, and OR
Only one state by law defines an embryo conceived through ART/IVF as a “juridical
person”: LA
Two states regulate the use and treatment of gametes, neonates, embryos, or fetuses:
MI and SD
One state has a law regarding inheritance rights of children conceived in IVF: MN
Four states have laws in effect providing some general guidance for embryo
donation: CA, OH, OK, and TX.
Three states have laws in effect providing some general guidance for embryo
donation and allow for embryo adoption: FL, GA, and LA.
One state requires some form of informed consent to be given in for egg donation:
AZ
Sickle cell anemia, and end-stage blad- productive cloning” only. This represents a sig-
der disease—using adult stem cells. nificant decline from 2009 activity levels when
No clinical use of human embryonic 11 states considered bans on human cloning.
stem cells has yet been published in
the scientific literature. Arizona enacted a measure prohibiting the in-
tentional creation of an embryo by any means
• A general misconception exists that other than fertilization of a human egg by a
there are two types of human clon- human sperm, thereby banning cloning for all
ing—“cloning-to-produce-children” purposes.
and “cloning-for-biomedical-re-
search.” In truth, these designations Michigan considered measures to restrict hu-
are simply two different rationales man cloning, specifically providing “an indi-
or justifications offered for the same vidual shall not intentionally transport, attempt
procedure, known medically as “so- to transport, or cause to be transported into the
matic cell nuclear transfer,” or human state a human embryo created through human
cloning. Both rationales are morally cloning.”
wrong because scientifically both be-
gin with the creation of a cloned hu- Destructive Embryo Research
man being at the embryonic stage of
life. The differing justifications that At least two states – Arizona and Mississippi
one clone is destined for implantation – considered bans on destructive embryo re-
in a womb and the other is destined search. This represents a significant decline
to be destroyed for its stem cells do from 2009 activity levels when 12 states con-
not—and cannot—change the basic sidered bans on destructive embryo research.
scientific fact that the cloned human
embryos created for both reproductive Arizona enacted a measure providing that “[a]
or therapeutic purposes are simultane- person shall not intentionally or knowingly en-
ously human beings. gage in destructive human embryonic stem cell
research (any research that involves the disag-
In 2010, 26 states considered approximately 83 gregation of any human embryo for the pur-
measures related to biotechnologies. This rep- pose of creating any human embryo or for the
resents a 13% decrease in the number of mea- purpose of creating human pluriopotent stem
sures considered (as compared to 2009 activity cells or human pluriopotent stem cell lines).”
levels). The most active states were Arizona,
California, Michigan, and New Jersey. Conversely, New Mexico and South Dakota
considered measures to promote or permit de-
Human Cloning structive embryo research.
At least two states – Arizona and West Virginia At least eight states – Arizona, California,
– considered complete bans on human cloning, Connecticut, Maryland, Michigan, Mississip-
while New Mexico considered a ban on “re- pi, New Mexico, and South Dakota – consid-
ered measures to regulate destructive embryo tives to destructive forms of embryo research,
research. including adult stem-cell research and research
using umbilical cord blood.
California established the Stem Cell Research
Advisory Committee whose members “shall Ohio enacted a measure requiring the Ohio
work to advance embryonic and human adult Department of Health to place printable infor-
stem cell research.” mation on umbilical cord blood banking and
donation on its web site. The Department of
California also adopted the Stem Cell and Bio- Health will also encourage health care profes-
technology Education and Workforce Devel- sionals to specifically provide this information
opment Act of 2009. The Act establishes “stem to pregnant women.
cell and biotechnology education and work-
force development” as a state priority; pro- Tennessee enacted a measure directing the
motes stronger links among Tennessee Department of
industry sectors, the state, Health to encourage health
the Institute for Regenera- care professionals to pro-
tive Medicine, and public vide pregnant women with
schools; and requires the a publication containing
State Department of Educa- information on cord blood
tion to post certain related banking.
information on its website
and to inform science teach- State Funding of Biotech-
ers and school districts of a nology
related curriculum.
Funding bans on cloning
Fetal Experimentation: and/or destructive embryo
research were considered in at least three states
Florida considered a measure providing that – Mississippi, Missouri, and New Jersey.
“no person shall use any live fetus or live,
premature infant for any type of scientific, re- Chimeras
search, laboratory, or other kind of experimen-
tation prior to or subsequent to any termination At least four states – Arizona, Michigan, Ohio,
of pregnancy procedure except as necessary to and Oklahoma – considered bans on the cre-
protect or preserve the life and health of such ation of chimeras (human-animal hybrids).
fetus or premature infant.”
Arizona enacted a measure banning the cre-
Ethical Forms of Research ation, transfer, and transportation or receipt of
human-animal hybrids.
At least seven states – Alabama, Illinois, Mary-
land, Massachusetts, Mississippi, New Jersey, Assisted Reproductive Technology
and Ohio – sought to promote ethical alterna-
Nearly 40% of this year’s biotechnology mea- Iowa and Minnesota considered measures re-
sures (32) related to assisted reproductive lated to parentage and inheritance rights of
technologies (ART) and surrogacy. Considered children conceived using IVF, including chil-
measures included regulations on ART, mea- dren conceived after the death of a donor-par-
sures related to parentage of children conceived ent.
using ART, and insurance coverage mandates.
At least seven states – Maine, Maryland, Mas-
California enacted a measure requiring that sachusetts, Missouri, New Hampshire, New
any advertising for egg donors (for fertility Jersey, and Pennsylvania – considered mea-
treatments) contain a statement “relating to the sures requiring insurance coverage for ART.
potential health risks associated with human
egg donation.” Another measure requiring Embryo Adoption
that a woman undergoing fertility treatments
document an “ongoing physician-patient” re- Two states – Massachusetts and Missouri –
lationship with “another physician” during and considered measures related to embryo adop-
following her fertility treatments was vetoed. tion.