An American woman has discovered a high school boyfriend she slept with and could easily have married is actually her half-brother.
This "horror story" has reopened discussions on the issue of "fertility fraud", said CNN. But what is this and what are the legal, regulatory and ethical dimensions?
An 'obvious, burning question'
Fertility fraud occurs when a doctor fails to obtain consent from a patient before inseminating her with his own sperm. For those affected, the results can be devastating.
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Growing up, Victoria Hill "never quite understood how she could be so different from her father", said CNN. The 39-year-old from Connecticut would make jokes that perhaps she was the postman's child.
But after taking a DNA test to explore a medical issue, she discovered that her biological father appeared to be Burton Caldwell, a fertility doctor who had been helping her mother conceive and had used his own sperm to inseminate her, allegedly without her knowledge or consent.
Then she found out that she had 22 half-siblings, including her high school boyfriend. "I was traumatized by this," she told CNN.
There are many similar cases. In Virginia in the 1990s, Dr Cecil Jacobson admitted to fathering as many as 75 children through artificial insemination between 1976 and 1988. Indiana doctor Donald Cline was found to have fathered 94 children before his arrest in 2016. Cline's story was later covered in a Netflix documentary called "Our Father".
More than 50 fertility doctors around the US have been caught or accused of furtively using their own sperm to impregnate their patients, said The New York Times. But campaigners told CNN there are more: they know of at least 80.
All of this opens up an "obvious, burning question", wrote Carol Midgley in The Times: why do doctors do this? Is it a "God complex", an "insidious form of rape" or "a misguided belief that he is 'helping' his patients?"
Those who have admitted to covertly using their own sperm have generally said they did it because there was a lack of available stock. Jacobson, for instance, said he used his own sperm in cases where only frozen sperm from a sperm bank was available.
This is of little comfort to many of those affected. "Some people call this horrific act medical rape," Adam Wolf, a lawyer who represented an alleged victim of fertility fraud, told Forbes, "but regardless of what you call it", the "heinous and intentional misconduct is unethical".
'I despise you but I'm grateful'
Unfortunately, legal redress is hard to come by. Most US states have no laws against fertility fraud: in 2019, Indiana became only the second state, after California, to pass legislation making it an offence.
One way to address the issue is to limit how many times a donor can donate. But in the US there are no legal limits on this, in contrast to Germany, where a donor may not father more than 15 children, and the UK, which limits it at 10 families. This "absence of criminality" in the US against fertility fraud reflects the "broader lack of regulation in reproductive medicine" there, said The Verge.
Some say that the issue is a historic one, which could not be repeated today. "The safety measures and safeguards currently in place would make [allegations of fertility fraud] virtually impossible," a spokesperson for the Boston IVF Fertility Clinic told The Associated Press.
But, depending on the US state and its definition of consent, "doctors often cannot be prosecuted for rape or sexual assault because their patients technically 'consented' to the insemination procedure", said The Verge.
Sometimes, those conceived after a case of fertility fraud choose to confront their father. Janine Pierson, who believes that Burton Caldwell impregnated her mother with his own sperm after falsely telling her that the donor would be a Yale medical student, visited his home announced.
"He was not in any way apologetic," she told CNN. But he did ask how many grandchildren he had and "was very curious" about her "scholastic achievements" and "how intelligent I was, basically".
Before she left, she took a selfie with him. "It was just like mixed emotions of, you know, like, I despise you, but at the same time, I’m grateful to be here," she said.
