Overview
The United States is a federal country in which the power to regulate is divided among the federal government and the fifty states. Many of the “freedoms” concerning research and medical treatment are regulate at the state level thus creating a patchwork rather than a uniform and consistent picture. A typical example is the regulation of physician assisted suicide: four states have legalized it (OR, VT, and WA legalized physician-assisted suicide via legislation and MT via court ruling); 39 states have laws prohibiting assisted suicide and AL, MA, WV and the District of Columbia prohibit assisted suicide by common law; NV, NC, UT, and WY have no specific laws regarding assisted suicide, may not recognize common law, or are otherwise unclear on the legality of assisted suicide. In our report and index, we highlighted the positive, that is, we recognize the fact that some American patients have a right to be assisted in committing suicide.
Similarly the state of affairs of research with embryo is complex. Current federal policy limits federally funded research to research conducted on embryonic stem cell lines created before August 2001. State laws may restrict the use of embryonic stem cells from some or all sources or specifically permit certain activities. State laws on the issue vary widely. Approaches to stem cell research policy range from statutes in California, Connecticut, Illinois, Iowa, Maryland, Massachusetts, New Jersey, and New York, which encourage embryonic stem cell research, to South Dakota's law, which strictly forbids research on embryos regardless of the source. Many states restrict research on aborted fetuses or embryos, but research is often permitted with consent of the patient. Almost half of the states also restrict the sale of fetuses or embryos. Louisiana is the only state that specifically prohibits research on in vitro fertilized (IVF) embryos. Illinois and Michigan also prohibit research on live embryos.
The regulation of abortion is by contrast more consistent across the nation since 1973 when in Roe v. Wade the Supreme Court invalidated all of laws prohibiting abortion and set guidelines for the availability of abortion (later refined in the majority opinion issued in 1992 in Planned Parenthood v. Casey). Casey sets the constitutional standards that are currently in place and identify in “fetal viability” the moment in which the state may claim a right to override the woman’s autonomy. The legal battles of the legality of abortion are mostly fought at the state level where pro-life activists advocate for the adoption of feticide laws, embryo-personhood amendments, and by imposing certain requirements that pregnant women must satisfy between the request of an abortion and its performance (ultrasound; parental consent or notification for minors; or mandatory waiting period and information).
With regard to assisted reproduction, the regulatory framework is a fragmented yet liberal one. The only federal legislation passed pertaining to assisted reproduction is the Fertility Clinic Success Rate and Certification Act of 1992 establishing the reporting of pregnancy success rates to the Centers for Disease Control and Prevention for publication. Regulation varies at the state level. Seven states have legislation that prohibits human cloning for both reproductive and research purposes, while eight states ban reproductive cloning. Other states prohibit commercial surrogacy or regulate surrogacy agreements. Several states require private insurance coverage of assisted reproduction technologies and regulate the donation of sperm, eggs, and embryos. Only Pennsylvania extensively regulates and monitors fertilization clinics and activities.
Two EC pills are approved by the U.S. Food and Drug Administration (FDA). The first one is Plan B, and it prevents pregnancy when taken within 72 hours of sexual intercourse. First approved in 1999 for prescription use only for women of all ages, this drug is now an over-the-counter drug for all women of child-bearing age. However, women under the age of 17 must obtain a prescription to obtain it. In August 2010, the FDA approved a new form of prescription-only emergency contraception, ella, which can prevent pregnancy if taken up to 120 hours, or five days, after a contraceptive failure or unprotected sexual intercourse. Mifepristone was approved for abortion in the United States by the FDA, in September 2000 and is not legal and available in all 50 states. It is a prescription drug, but it is not available to the public through pharmacies but through specially qualified licensed physicians.
Abortion
95 pts out of 100 / 100,00% complete
Abortion and contraception allow women to express their freedom of reproduction by exercising their right of self-determination over their bodies.
Measurement questions
Is abortion lawful to protect woman's life?
Yes
Is abortion lawful to protect woman's physical health?
Yes
Is abortion lawful to protect woman's mental health?
Yes
Is abortion lawful in the event the woman was raped?
Yes
Is abortion lawful in the event of fetal defects?
Yes
Does the law mandate that an abortion is performed at the mere request of a pregnant woman?
Yes
Is RU-486 (Mifepristone) approved or registered for use?
Yes and it is available with prescription
Are emergency contraception drugs lawfully available?
Yes, over the counter
Are family planning services provided through government-run programs and facilities?
Yes, directly
Is spousal notification/permission required?
No
Assisted Reproduction
92 pts out of 100 / 100,00% complete
Assisted reproductive technologies (ARTs) are the methods used to achieve pregnancy by artificial or partially artificial means. Access to assisted reproduction concerns our ability to expand our right to health by offering us access to treatment to overcome infertility.
Measurement questions
Is preimplantation genetic diagnosis permissible?
Yes with no restrictions
Is oocyte cryopreservation permissible?
Yes
Is embryo cryopreservation permissible for reproductive purposes?
Yes
Is sperm donation permissible?
Yes
Is oocyte donation permissible?
Yes
Are IVF surrogacy agreements enforceable?
Yes, commercial and not
Marital status requirements?
No
Do same-sex couples have access to ART?
Yes
Do single women have access to ART?
Yes
Are there any limits on the number of pre-embryos that can be transferred?
Yes
End of life
60 pts out of 100 / 100,00% complete
End of life decisions concern our ability to make choices concerning the end of our lives and take of the form of refusal of life sustaining treatment, being help in committing suicide, choosing euthanasia, and make choices that must be upheld even when the person becomes unconscious. As Young (2010) noted, "People have an interest in making important decisions about their lives in accordance with their own conception of how they want their lives to go."
Measurement questions
Is passive euthanasia lawful?
Legally prohibited
Is active euthanasia lawful?
Legally prohibited
Is physician-assisted suicide lawful?
Yes
Are advance directives (AD) enforceable?
Yes
Is a physician required to respect a patient's refusal of life-sustaining treatment?
Yes
Research with embryos
61 pts out of 100 / 100,00% complete
Research with embryos and pre-embryos as well as therapeutic cloning concerns scientists’ freedom to investigate human biology as well as patients’ freedom to access regenerative medicine treatments that may be developed as a result of research with human embryonic stem cells. Since the early 2000s, research with embryos has been at the center of an often-polarized debate about the nature and scope of scientific freedom.
Measurement questions
Is basic research using germline modification in human embryos/gametes permitted?
Yes
Is pre-clinical research using germline modification technologies in animals permitted?
Yes
Is clinical research using germline modification technologies in humans permitted?
Restricted
Are clinical applications of research using germline modification technologies (i.e., to initiate a pregnancy with edited embryos or with edited gametes) permitted?
No
GM Crops
80 pts out of 100 / 100,00% complete
GM crops have contributed significantly to modern agriculture. Plant breeding using genetic modification techniques has led to improving crops in more targeted ways than classical breeding techniques. GM crops acquire desirable characteristics, including pest and herbicide resistance, enhanced robustness against diseases, drought or water tolerance, and healthier profiles that can enhance nutrition.
Measurement questions
Is research on GMOs permitted in the laboratories?
Yes
Is notification to start research on GMOs in laboratories required?
Yes
Is research on GMOs frequent?
Yes
Are GM crop field trials (the limited release into the environment for research purposes) permitted?
Yes
Is authorization to start a GM crop field trial required?
Yes/prohibited
Are GM crop field trials frequent?
Yes
Is cultivation of GM crops (for commercial purposes) in open field permitted?
Yes
Is authorization to start open field cultivation of GM crops required?
Yes/prohibited
Is open field cultivation of GM crops frequent?
Yes
Can GM crop commodities harvested in other countries be imported?
Yes
Is authorization to import GM crop commodities required?
Yes/prohibited
Is the import of GM crop commoties frequent?
Yes
Right To Science Indicators
Measurement questions
- Access to benefits
What is the total general government expenditure on education?
13.45
What is the expenditure on tertiary as % of government expenditure on education?
27.5
What is the the percentage of population ages 25 and over that attained or completed a doctoral degree or equivalent?
1.7
What is the percentage of population that uses the Internet?
76.18
What is the quality of math and science education on a scale from 1 to 7 being "excellent"?
5.4
To what extent is the Internet used in schools for learning purposes?
5.9
What is the scientific literacy of 15-year-old students as measured by the Programme for International Student Assessment (PISA)(mean score)?
496
- Opportunities to participate
Does the law mandate nondiscrimination based on gender in hiring?
Yes
What is the percentage of females employed with advanced degrees out of total employed?
- Enabling environment
How many scientific and technical journal articles are published each year in physics, biology, chemistry, mathematics, clinical medicine, biomedical research, engineering and technology, and earth and space sciences?
408985.3
What is the percentage of GDP allocated to Research and Development?
2.79
How may published articles have received at least H citations in the period 1996–2014?
100
What is the quality of scientific research institutions?
6
To what extent do business and universities collaborate on research and development (R&D)?
5.7
What is the average university ranking score of countries based on their top 3 universities?
99
To what extent are scientists and engineers available?
5.7
How many professionals are employed as researchers?
9.1
How many professionals are employed by government as researchers?
4.5
- International cooperation
To what extent are talented people attracted from abroad?
5.8