What future doctors, lawyers, and theologians think about assisted reproduction
Attitudes towards medically assisted reproduction among students in three Euro-Mediterranean countries. (Tutić Grokša, 2025)
Tutić Grokša, I., Depope, A., Trako Poljak, T., Buterin, T., Doričić, R., Rinčić, I., Gensabella, M., Zagorac, I., Eterović, I., Kalokairinou, E., Kaluđerović, Ž., Guć, J., Vantsos, M., Giacobello, M. L., & Muzur, A. (2025). Attitudes towards medically assisted reproduction among students in three Euro-Mediterranean countries. Ethics in Progress, 16(2), 4–30. https://doi.org/10.14746/eip.2025.2.1
Geographic Region: Croatia, Italy, and Greece
Research Question: Do students from Croatia, Italy, and Greece differ in their attitudes toward medically assisted reproduction (MAR), and how do field of study, gender, religiosity, political orientation, financial status, and community size predict those attitudes?
Design: Cross-sectional, quantitative survey study conducted between December 2022 and June 2023 as part of the larger EuroBioMed project (”From diversity of traditions to a common Euro-Mediterranean bioethical platform”). Students completed a paper-based questionnaire in class at five universities across three countries. The primary measure was a 14-item medically assisted reproduction (MAR) instrument, adapted from an earlier Croatian sociological scale (Cifrić, 2005) and expanded to include contemporary bioethical topics. Principal Component Analysis was used to reduce the scale. Five items were removed due to weak correlations with the remaining items: children’s right to know their donor, legal regulation, economic motivation, doctors’ rights over gametes, and the use of embryos in research. The final 9-item scale had good reliability and explained 51% of the variance, labeled “Disapproval of MAR” (higher scores = more disapproval).
Editor’s Note: The items retained in the scale primarily reflect views on gamete/embryo donation bans and MAR access, not attitudes about transparency or rights for donor-conceived people.
Sample: 1,097 students (mean age 24, range 19–74 years) from five universities across three countries: Croatia (60%, n=656), Italy (23%, n=254), and Greece (17%, n=187). Students came from four academic disciplines: law (37%), medicine (30%), philosophy (20%), and theology (13%). Women made up 60% of the sample. Most participants (61%) identified as believers. Regarding political orientation, 29% identified as left, 26% as center, 19% as right, and 25% as not interested in politics. Financial status was self-reported, with approximately half (50%) rating themselves as average. Participants were recruited via convenience sampling in class settings with instructor permission. Participants were not asked about personal or family experience with assisted reproduction, donor conception, or infertility.
Key Findings
The individual items with the highest levels of agreement across the full sample were: children’s right to know their biological origins/donor information (77% agreement) and the need for legal regulation of MAR (70% agreement).
Just over half of participants (51%) agreed that MAR should be available to single people or people in same-sex partnerships.
Very few participants supported banning the creation of surplus embryos (25%), banning the donation of surplus embryos (21%), or banning gamete donation altogether (18%). These were the least endorsed restrictions.
There was a statistically significant difference in overall MAR disapproval score between countries, but the effect size was very small. The country of origin explained less than 1% of the variance in attitudes.
The only statistically significant difference was between Italy and Greece. Italian students showed slightly more disapproval of MAR; Greek students showed slightly less. Croatian students fell in between. The authors attribute the Italy-Greece difference partly to Italy’s restrictive ART law and Greece’s comparatively permissive ART regulations.
Field of study was the strongest predictor of MAR attitudes, with a large effect size, meaning academic discipline explained about 46% of the variance in attitudes.
Theology students scored dramatically higher on MAR disapproval compared to philosophy students, medical students, and law students. All differences involving theology were statistically significant.
No statistically significant differences were found among philosophy, medicine, and law students. Law students had the lowest disapproval scores (i.e., most supportive of MAR access).
Women had significantly lower MAR disapproval scores than men. Gender explained a meaningful portion of the variance.
Believers had significantly higher MAR disapproval scores than both indifferent respondents and non-believers, with a large effect size. No significant difference was found between the indifferent and non-believer groups. Religiosity was one of the most powerful individual-level predictors.
Right-oriented participants had the highest MAR disapproval; left-oriented participants had the lowest, with a large effect size. Differences between center and ‘not interested’ groups were not significant.
Limitations: The MAR instrument is new and has not been widely validated. The scale collapses attitudes across very different dimensions of MAR (gamete donation, accessibility, embryo handling) into a single ‘disapproval’ score. This may obscure meaningful variation in which specific aspects of MAR are viewed negatively vs. positively. The cross-sectional design prevents causal conclusions. Use of an English-language questionnaire may have presented comprehension challenges for students with lower English proficiency. Terminology for MAR procedures may have been unfamiliar.
Applications: Jurisdictions that share cultural roots or have common identities can have differing legal, theological, and socio-political contexts, which influence people's orientations toward medically assisted reproduction.
Funding Source: Croatian Science Foundation under project IP-2020-02-7450.
Lead Author: Ivana Tutić Grokša is a researcher at the Adult Education Institution Dante in Rijeka, Croatia, and is affiliated with the Department of Social Sciences and Medical Humanities at the Faculty of Medicine, University of Rijeka, where she has published on Mediterranean bioethics, transgender minority stress in Croatia, and diversity competency in healthcare. No personal connection to donor conception was disclosed.
Regulatory Context
Croatia
Croatia’s Law on Medically Assisted Fertilization (Official Gazette 86/12) permits both homologous and heterologous fertilization.
Egg donation is legal but no local egg donors are available, so eggs must be imported. Sperm donation is permitted. Surrogacy is prohibited. Post-mortem fertilization is prohibited.
Single women can access MAR via donated eggs. Same-sex couples do not have legal access to MAR in Croatia.
Donors are not required to be identifiable; the law does not mandate identity-release donation.
Italy
Donor conception was permitted following a Constitutional Court ruling in 2014.
Access is limited exclusively to different-sex married or cohabiting couples—single women and same-sex couples are excluded.
Anonymous donation is mandatory; donor-conceived individuals have no legal right to identifying information about their donors.
Surrogacy is prohibited and since 2023 has been criminalized even when performed abroad by Italian citizens.
Embryo donation is prohibited.
The restrictions have contributed to significant cross-border reproductive travel, with many Italian residents seeking treatment in Greece, Spain, and other countries.
Greece
Surrogacy is legal under court-approved arrangements. The upper age limit for women accessing MAR is 54, compared to 45 in most European countries. Egg donation, sperm donation, and embryo donation are all permitted.
Single women have access to MAR. Same-sex female couples do not have legal access to MAR through the standard framework, though surrogacy is accessible to some.
Greece is a significant destination for cross-border reproductive travel, receiving approximately 1,000 patients per year from countries with more restrictive laws (including Italy and Germany).
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