Marriage and Family Legal Aspects
Same-sex attraction occurs in humans across all cultures, educational levels, career paths, socioeconomic levels, religions, and personalities (Szymanski, 2008; McAuliffe, 2005). In 2022 it was estimated that about 7% of Americans are gay, lesbian or bisexual (Key findings about LGBTQ+ Americans for Pride month | Pew Research Center. The potential stigma surrounding coming out as a gay, lesbian, bisexual or transgender person may result in underreporting.
According to Gay & Lesbian Advocates & Defenders (2008), marriage is defined as “a unique legal status conferred by and recognized by governments the world over”. Not only does a marriage offer certain rights and protections, it declares to the world a couple’s love and commitment for each other. A civil union provides legal protection to couples at the state law level, but omits federal protections as well as the dignity, clarity, security and power of the word ‘marriage’” (Gay, 2008). Depending on the state, a domestic partnership can ensure some protection similar to marriage or simply allow same-sex couples to declare their commitment and pledge to be responsible for the other person’s financial obligations.
There are many legal protections and responsibilities that accompany a marriage, many of which have been denied to same-sex couples (Gay, 2008). These benefits include affordable housing programs, employee benefits, tax laws, and death benefits among many others. Partners in a civil union receive rights based on the state in which they are partnered. While a marriage is recognized worldwide, civil unions are not recognized from state to state. Divorce proceedings too are different for married couples versus those in a civil union. Partners in a civil union must be a resident of the state that granted the union in order to receive a divorce; married couples can be a resident of any state. Similarly, a spouse can make any medical decisions regarding their partner. If a partner in a civil union is injured in a state that doesn’t recognize their partnership, this person may not be recognized as a family member, may not be allowed to make medical decisions, and may not be able to even visit the patient. If the patient should die, the partner may be denied the right to plan a funeral or receive bereavement (Herek, 2006). More recently, however, these challenges have been attaining national recognition and are improving. On April 15, 2010, President Barack Obama issued an Executive Order “Respecting the rights of Hospital Patients to Receive Visitors and to Designate Surrogate Decision Makers for Medical Emergencies”. See the Presidential Memorandum at: https://obamawhitehouse.archives.gov/the-press-office/presidential-memorandum-hospital-visitation
Formation of Families by GLBT Persons
The desire for children is a basic human instinct felt by lesbians, gay men, and heterosexuals alike. Humans desire to be parents for the same reasons regardless of their sexual orientation (Ames & Chabot, 2004).Fifteen percent (14.7%) of the 1.1 million same-sex couples in the United States in 2019 had at least one child under 18 in their household (Fifteen Percent of Same-Sex Couples Have Children in Their Household (census.gov), by adoption, surrogacy, foster parenting, and/or assisted reproductive technology.
The ART technique used in this case by Lisa and Jamie is called in vitro fertilization (IVF), which involves combining a woman’s eggs and man’s sperm outside of their bodies in a laboratory. After the egg(s) are fertilized, the embryos are transferred to the woman’s uterus. All types of IVF may be done with the couple’s own eggs and sperm or donor eggs or sperm. Donor eggs and sperm are typically obtained from a donation bank and undergo extensive medical and genetic screening (American Society, 2008). If a pregnancy is carried by the egg donor, the woman is considered a traditional surrogate. If the pregnancy is carried by a woman who has no relation to the baby, she is considered a gestational carrier. Lesbian couples typically allow one partner to be the egg donor and the traditional surrogate. For gay males to parent, they may use an egg donor who can also be a surrogate or an additional female to be the gestational carrier (American Society, 2008). Due to common stereotypes, ART programs throughout the United States have been found to widely accept lesbian couples, but are less likely to accept gay male couples (Greenfeld, 2007).
There are medical risks associated with IVF for each step of the procedure. Women preparing to undergo IVF or ovum donation receive ovulation induction or fertility drugs to allow for growth of multiple eggs in the ovaries each month. These women are at risk for ovarian hyperstimulation syndrome (OHSS) which can lead to the development of fluid in the abdominal cavity, excessive weight gain, over-concentration of the blood, and even kidney failure or death. There are also risks associated with retrieval of eggs similar to any general surgery that requires anesthesia. Additional risks involve the possibility of the aspirating needle causing damage to the bladder, a blood vessel, or the bowel during egg retrieval. After fertilization, embryo transfer can cause cramping and bleeding with the rare chance for an infection (American Society, 2008). Anytime multiple embryos are inserted into the uterus, there is a higher chance for multiple pregnancies. The risks involved with a multiple birth pregnancy include premature delivery, maternal hemorrhage, gestational diabetes, and early or prolonged bed rest. Miscarriage rates after IVF are very similar to the general population. The rate of a miscarriage when the mother is in her twenties is 15%. If a mother is in her forties the rate is 50% (American, 2007). According to Correa et al. (2009), among single births, ART was found to be associated with septal heart defects, cleft lip with or without cleft palate, anorectal atresia and esophageal atresia. ART resulting in multiple births was not found to be significantly associated with these birth defects. The mechanisms are not yet clear as to why these birth defects are more common in babies conceived via ART (Correa et al., 2009).
It is important to consider the financial, physical, and emotional effects IVF has on a couple. The treatments are expensive and patients are known to hold high expectations. Failure is common, however, leaving couples feeling resentful and frustrated. Couples are often encouraged to seek psychological counseling to help manage the stress of the situation. Many ART clinics have mental health professionals on site to work with couples who are dealing with anxiety and grief (American Society, 2008). When performing a psychosocial assessment and providing psychosocial counseling, it is important to remember that all relationships share many of the same attributes, regardless of the sexual orientation of those involved. Members of both same-sex and heterosexual relationships form strong emotional attachments and face challenges concerning loyalty, intimacy, stability, and love.
