Ethical Considerations in Post-Mortem Sperm Retrieval: A Comprehensive Review

This comprehensive review delves into the moral and ethical dilemmas surrounding post-mortem sperm retrieval (PMSR) and its implications for creating new individuals. The paper examines the challenges posed by unusual requests for sperm retrieval from the deceased's widow and parents, as well as the broader socio-ethical considerations associated with PMSR. These requests have often been denied due to the absence of established laws and guidelines governing posthumous sperm retrieval and subsequent births, which were once deemed impossible. While some countries have implemented institutional policies to regulate its use to some extent, there remains a lack of standardized rules and procedures for the collection and retrieval of sperm after death. It is essential to introduce institutional guidelines to facilitate requests for assisted reproductive technology (ART) following successful sperm retrieval. Additionally, the development of PMSR legislation is necessary to ensure a proper balance between the moral rights and fundamental rights of the deceased, their family, and any current or future offspring, while providing adequate protection for all parties involved.

It Takes a Village to Raise a Child: Solidarity in the Courts-Judicial Justification for Posthumous Use of Sperm by Bereaved Parents

The practice of posthumous use of sperm raises social, ethical, and legal questions. We examine the issue of who should be allowed to use the sperm-only the deceased's spouse or the deceased's parents as well-from the perspective of solidarity and relational autonomy. Following a theoretical discussion of various accounts of solidarity and relational autonomy, the legal status of posthumous assisted reproduction is examined in three jurisdictions-the USA, Australia, and Israel-in which most applications to the courts were submitted by the deceased's parents. In Israel, we found fifteen court rulings on requests for posthumous use of sperm and fourteen in Australia. A smaller number were found in the case of the USA. The analysis reveals that Israeli and Australian courts employ solidarity-based arguments to justify their decisions to allow posthumous use of sperm, particularly when the deceased's true wishes are unknown. We thus conclude that the posthumous use of sperm can be legally extended to include the deceased's parents based on solidarity and relational autonomy arguments.

Parents' posthumous use of daughter's ovarian tissue: Ethical dimensions

In recent years, progress in cancer treatment has greatly increased the chances of recovery. Yet, treatment may have irreversible effects on patients' fertility. In order to protect future fertility, preservation of ovarian tissue may be offered today even to very young girls, involving a surgical procedure that may be performed by minimally invasive laparoscopy, under general anesthesia. However, in the tragic event of a girl's death, questions may arise regarding the possible use of the preserved ovarian tissue by her parents. Should posthumous reproductive use of ovarian tissue without the girl's prior consent (due to her young age) be considered a violation of her rights? On the other hand, can it be argued that it is in the interest of a child who died young to leave a genetic trace through posthumous reproduction, because genetic continuity is in the interest of every human being? After presenting the relevant clinical facts, we explore the ethical dimensions of this possible practice through an analysis of the interests of the deceased, her parents, and the child that may be born posthumously.

Reproductive function: the protection of the rights of the people which are sent to the area of the fighting

OBJECTIVE

Introduction: The issues of problems of the legal regulation of posthumous reproduction in Ukraine and foreign countries are analysis in the article. The author substantiates the necessity in the creation and acceptance of the State Program of the retrieval of reproductive cells in people who are sending to the area of the fighting. The aim:the purpose of our work is a comprehensive study of post-mortem (post-mortem) reproduction and substantiation of the possibility and necessity of adopting a state program for the selection of reproductive cells of individuals who are sent to a combat zone to ensure their full social protection and assistance in the realization of the right to fatherhood or motherhood.

PATIENTS AND METHODS

Materials and methods: the experience of certain countries is analyzed in the research. Additionally, we used statistical data of international organizations, conclusions of experts and foreign legal acts dealing with posthumous reproduction and auxiliary reproductive technologies, judicial practice, doctrinal ideas and views on this issue.

RESULTS

Review: there are medical (practical) preconditions for the introduction of posthumous reproduction programs. Among them is the technology of obtaining reproductive cells (post-mortem too), their preservation and successful subsequent use. In addition, foreign experience shows the success of the application of these technologies and the real guarantee of full implementation of the range of rights to the family, fatherhood or maternity.

CONCLUSION

Conclusions: we note the urgent need to develop and adopt a state reproductive cell selection program for individuals who are sent to the combat zones (according to a model that exists in such countries as the USA and Israel).

Posthumous Reproduction: A Consideration of the Medical, Ethical, Cultural, Psychosocial and Legal Perspectives in the New Zealand Context

This paper describes the development of New Zealand policy on posthumous reproduction in assisted human reproduction. It outlines five perspectives: medical, ethical, cultural, psychosocial and legal and shows the multidisciplinary approach taken by the National Ethics Committee. It is argued that each of these perspectives has important contributions to make to the multidisciplinary approach. The guidelines determined by the Committee are outlined, along with the processes used in arriving at these.

The Case of Ms D: A Family's Request for Posthumous Procurement of Ovaries

The MedStar Washington Hospital Center clinical ethics team became involved in a case when the family requested the posthumous removal of a patient's ovaries for future reproductive use. This case presents a novel question for clinical ethicists, since the technology for posthumous female reproduction is still in development. In the bioethics literature, the standard position is to refuse to comply with such a request, unless there is explicit consent or evidence of explicit conversations that demonstrate the deceased would have wanted this option pursued. Ms D's case, we suggest, offers an exception to this default position; complying with the family's request could have been ethically permissible in this case, had it been medically feasible.

Analysis: A Legal Perspective

This commentary summarizes the uncertain state of the law regarding consent for posthumous gamete retrieval. The emergence of a legal framework will be aided by the kind of ethical analysis prompted by this family's request for removal and preservation of a deceased patient's ovaries.

Analysis: OB/GYN-Genetics

Ovarian salvage from a patient with brain death is not available and will not preserve viable ova for future reproduction. Previous interest in assisted reproductive technology is only the first step in this process, which requires careful assessment of maternal risks and potential for recurrent genetic disease.

Analysis: Fertility Preservation

This commentary considers the viability of ovarian tissue cryopreservation (OTC) in the case of an adult who qualified for brain death. Although there has been some success with OTC in achieving pregnancy when the tissue is reimplanted in the original donor, attempting OTC in the case under discussion would have not been medically feasible.

How Clinicians Can Reduce "Bullied Acquiescence"

Clinicians and patients and their families may disagree about a course of treatment, and the ensuing conflict may seem intractable. The parties may request mediation, or use mediation-based approaches, to help resolve the conflict. In the process of mediation, and at other times, parties in conflict may feel so pressured to accept a resolution that they acquiesce unwillingly--and such resolutions often unravel. In this article I investigate how "bullied acquiescence" might happen, and how to avoid it.

[POST MORTEM PATERNITY]

Post mortem paternity, namely the procreation after the death of the man whom is part of the couple, is one of the questions which raised the most hesitations since the first bioethics laws of 1994. The National Assembly, encouraged by several opinions of the CCNE (National advisory committee of ethics) had let itself convince that the transfer had, at least, to be authorized in utero embryos preserved at the regard of which no one could not claim to have rights equal or higher than those of the woman concerned. However, the Senate always ended up obtaining the maintenance of an absolute prohibition of posthumous procreation (starting) from the spermatozoids or frozen embryos. This indifference with the cruelty of the application of the law to the women plunged into mourning--based on a paradoxical appreciation of the interest of the child not to be born orphan, and on a not very glorious taking into account of the interest of the Body of notaries not to change its practices--is particularly debatable. One can, nevertheless, try to understand it according to the obsession of the legalization of surrogate motherhood by application of the principle of nondiscrimination which could justify the requests of the men who, thanks to a surrogate mother, would wish to become fathers starting from gametes or embryos taken or created before the death of their wife or partner.

Perimortem gamete retrieval: should we worry about consent?

Perimortem gamete retrieval has been a possibility for several decades. It involves the surgical extraction of gametes which can then be cryo-preserved and stored for future use. Usually, the request for perimortem gamete retrieval is made by the patient's partner after the patient himself, or herself, has lost the capacity to consent for the procedure. Perimortem gamete retrieval allows for the partner of a dead patient to pursue jointly held reproductive aspiration long after their loved one's death. But how can we know if the dying patient would have consented to gamete retrieval? In the UK, consent is a legal necessity for storing or using gametes-but this is not always enforced. Moreover, although the issues related to posthumous reproduction have been discussed at length in the literature, few commentators have addressed the specific question of retrieval. Gamete retrieval is an invasive and sensitive operation; as with any other intervention performed on the bodies of dead or dying patients, the nature and justification for this procedure needs to be carefully considered. In particular, it is important to question the idea that consent for such an intervention can be inferred solely from a person's known wishes or plans concerning reproduction.

"Let Me Keep My Dead Husband's Sperm": Ethical Issues in Posthumous Reproduction

The feasibility of posthumous reproduction when the surviving partner is female has brought to light many ethical, moral, social, and legal issues. This review aims to summarize these issues and to assist clinicians who may be faced with such requests. A question list, used for health technologies assessment, was utilized in a question-answer approach as the review methodology. Of the 1,208 publications identified through a comprehensive literature search in biomedical, psychological, and ethical databases, 31 articles included arguments related to one or more questions from the predefined question set. Key stakeholders identified include the deceased, the requesting party, the resultant child, the physician, and society. Key ethical issues relevant to posthumous reproduction include the four traditional pillars of medical ethics--autonomy, beneficence, nonmaleficence, justice--as well as the stakeholders' rights and sociocultural attitudes. The ethical framework formulated by these issues has been incorporated in a clinical ethics decision-making tool that could prove useful to clinicians and decision makers.

Responding to Requests for Assisted Reproductive Technology Intervention Involving Women Who Cannot Give Consent

One of the plots of the Canadian science fiction thriller Orphan Black involves a scheme to create dozens of siblings by harvesting the eggs of one woman, fertilizing them with the sperm of a single man, and implanting them for gestation in dozens of apparently willing surrogates.¹ The casualness of the procedure speaks to how comfortable we have all become with reproduction by technology. Yet there are still aspects of this process that remain outside the normative boundaries of most of our worldviews. This article considers recent advances in assisted reproductive technology (ART) that can result in a viable, fertilized embryo even when the mother is herself either permanently unconscious from a severe injury or has actually lost all brain function and therefore meets the legal criteria for brain death. It reviews these advances and applies them to four scenarios, or vignettes, that represent different concerns about the prospective mother’s intent to reproduce before losing her ability to give consent.

[Being a family today - ethics for assisted reproductive techniques]

Currently in France, all the children born as a result of an assisted reproduction procedure, represent 2.5% of all births. Although this proportion is not high, it is not to be neglected, particularly with regard to the sociological issues raised by assisted reproduction technologies (ART) - i.e. removing anonymity of gamete donation, post mortem insemination, ART access to single women and gay couples, surrogacy - to name four of the most prominent debates. What is new with ART is that a new therapeutic target of medicine is being developed, in other words procreation. Now it is no longer necessary for a man and a woman to resort to sex to have a child. This is a profound questioning of the representation of what appeared to be intangible, with some sort of divine aura. How, in this context, developing an ethics for ART? From a fethnographic field survey, we show here how this ethos of ART develops and how, therefore, we consider the multiple ways of being a family today.

Can ethics survive the onslaught of science?

The issue on which I will attempt to cast some light is certainly not novel. It has been ongoing for many years but the pace of scientific progress is gathering and the retreat of ethical barriers is relentless. I will illustrate my thesis by using examples of legal decisions from the realm of assisted human procreation and the posthumous conception of children from the sperm of deceased fathers e.g., the cases of Diane Blood, Parpalaix and Nikolas Coltan Evans. I will also highlight the recent case of Ashley X, a nine year old girl whose parents authorised radical medical treatment to arrest her development. I will argue that the law is being driven to roll back the ethical standards derived from our legacy of Natural Law by the imperatives of human rights e.g., the right to found a family, and the quest for patient autonomy. These are both admirable goals but fulfilling these goals comes at a cost to cherished ethical values e.g., that children are conceived by living fathers and that indulging the personal desires of every individual cannot forever be encompassed. As our legislators and courts chip away at our core network of ethical values, are they replacing them with equivalent values or do their decisions amount to a hollowing out of the core ethical values e.g., Thou shalt not kill and that human life is sacrosanct? Yet abortion is legal in many countries as is euthanasia. Paradoxically there is legislative protection for embryos by limiting experimentation on these clusters of cells. How do you construct a rational ethical framework with such blatant legal inconsistencies in the protection of human life? The sanctity of human life constitutes one of the fundamental pillars of ethical values which, in turn, support much more of the structure of ethics. Is a society that permits freezing the development of a nine year old child not a society whose ethics are so compromised that it is doomed to defend an ever diminishing mass of ethical values? Is there a core of ethics which is sacrosanct or is every ethical frontier fair game for invasion? Are the Ethics Committees, which approve and monitor research in the field of bioethics in Universities. Hospitals and laboratories failing in their duty as gatekeepers? They are after all the first line of defence for the survival of crucial ethical values. Can we continue to indulge the whims and needs of every individual under the guise of human rights or patient autonomy? Can a civilised society endure as such with an ever diminishing mass of ethical values?

Ethical quandaries in gamete-embryo cryopreservation related to oncofertility

While cancer rates continue to increase, therapy has dramatically decreased the mortality rates. The increased efficacy of current therapies may unfortunately have profound toxic effects on gamete function in both adolescent and reproductive age groups, with infertility as an expected consequence of cancer therapy. Significant progress in the advancement of fertility preservation therapies provides realistic options for future fertility in cancer survivors. However, a number of challenging issues need to be considered when presenting fertility preservation options. This overview highlights some of these considerations including religious-cultural-ethical values, access to care and cost of services, developmental capacity and consent, and posthumous reproduction.

Teaching medical ethics and law

The teaching of medical ethics is not yet characterised by recognised, standard requirements for formal qualifications, training and experience; this is not surprising as the field is still relatively young and maturing. Under the broad issue of the requirements for teaching medical ethics are numerous more specific questions, one of which concerns whether medical ethics can be taught in isolation from considerations of the law, and vice versa. Ethics and law are cognate, though distinguishable, disciplines. In a practical, professional enterprise such as medicine, they cannot and should not be taught as separate subjects. One way of introducing students to the links and tensions between medical ethics and law is to consider the history of law via its natural and positive traditions. This encourages understanding of how medical practice is placed within the contexts of ethics and law in the pluralist societies in which most students will practise. Four examples of topics from medical ethics teaching are described to support this claim. Australasian medical ethics teachers have paid less attention to the role of law in their curricula than their United Kingdom counterparts. Questions like the one addressed here will help inform future deliberations concerning minimal requirements for teaching medical ethics.

Pushing the dead into the next reproductive frontier: post mortem gamete retrieval under the uniform anatomical gift act

In re Matter of Daniel Thomas Christy authorized post mortem gamete retrieval under the most recent revision of the Uniform Anatomical Gift Act. This article recommends that the National Conference of Commissioners on Uniform State Laws explicitly address the issue of post mortem gamete retrieval for reproductive purposes; that legislators specify whether their states will follow the Christy ruling; and that ethics committees and consultants prepare for the questions about human identity and self determination that post mortem gamete retrieval raises.

Posthumous reproduction: consent and its limitations

The majority of the extensive debate surrounding posthumous sperm procurement (PSP) focuses on how to respect the deceased man and his autonomy. Policy and law also focus on the deceased's interests, specifying the level of consent required. This article argues (using four hypothetical fact situations) that consent should not be the sole focus of ethical debate. Instead, a fuller picture should be examined, including the wishes and values of the prospective sperm donor; the future life and prospects of the resultant child; the needs and motivations of the mother, and other pertinent factors. In practice, this means that a committee acting judicially should consider each case. This is a practical option for New Zealand and Australia where applications for posthumous sperm procurement are not common but it also enables us to consider the ethical arguments in relation to such determinations in other jurisdictions.

An unusual petition for posthumous sperm retrieval? What does it add to the debate?

Posthumous sperm retrieval is still a controversial procedure. The Israel Ministry of Health has recently issued guidelines to regulate the procedure and a recent unusual petition in Israel for posthumous retrieval sheds new and interesting light on the dilemmas involved. This paper examines the petition, both in its own right and by comparing it to the more frequent situation where the surviving partner of a suddenly deceased man petitions for his sperm to be collected for insemination into herself. The analysis considers the best interests of the child to be born, the good of other family members, the wishes of the deceased and the interests of society as a whole.

Attitudes toward posthumous harvesting and reproduction

Attitudes toward posthumous harvesting of reproductive material and beliefs about medical professionals' obligation to assist were examined using a multiple segment factorial vignette survey design with 407 randomly selected respondents from a southern state. Attitudes and beliefs were primarily shaped by the vignette couple's marital status, parental support, and evidence of the deceased's wishes, as well as by respondents' religiosity and level of education. Three primary groups of respondents were identified: libertarians emphasized the survivor's rights, consentualists were skeptical until hearing that the deceased approved of the procedure, and persistent dissenters retained their negative attitudes despite the deceased's known wishes in favor of posthumous harvesting. Overall, attitudes and obligation beliefs were primarily in favor of posthumous harvesting when contextual circumstances deemed suitable were portrayed.

Medically mediated reproduction: posthumous conception and the best interests of the child

Advances in medical technology have provided the means for posthumous reproduction to become a foreseen and intended event. This "medically mediated", "non coital" form of reproduction raises a number of esoteric legal and ethical issues, and has much to teach us about broader issues of personal autonomy, parenthood, gender relations, family structure and the best interests of the child. In this article the author, drawing on recent Australian jurisprudence, argues that the best interests of the potential child should be the primary consideration in any case involving posthumous conception. Drawing heavily on the normative foundations provided by international law, the author attempts to identify and clarify the interests of the child relevant in the context of posthumous conception. The author concludes that a denial of access to treatment, on the basis that treatment is contrary to the best interests of the child, has no sound basis. The current treatment of the interests of the deceased and surviving partner and the interests of the child as conflicting dichotomies fails to recognise the inherent logic in converging these interests. It is only in stripping away this discriminatory façade that one comes to recognise that the promotion of the rights of the deceased and surviving partner is likely, in many cases, to enhance the best interests of the child.

Belgian law on medically assisted reproduction and the disposition of supernumerary embryos and gametes

Abstract

Although medically assisted reproduction has been widely practiced in Belgium, it took decades before a majority was found to adopt a law to regulate this field. The new law recognises different family forms and a diversity of ethical positions. It regulates four main substantive elements: the disposition of embryos created in the context of assisted reproduction, the general rules (anonymous, free and voluntary) governing gamete and embryo donation, specific applications of assisted reproduction like post-mortem reproduction and finally the use of preimplantation genetic diagnosis for HLA typing. Beside the substantive topics, the law contains a number of rules of a more practical nature: the need for a contract, a maximum storage period, the right of physicians to refuse treatment on the basis of conscientious objections and the procedure that has to be followed when a patient is refused.

ESHRE Task Force on Ethics and Law 11: Posthumous assisted reproduction

This article analyses the different ethical aspects of posthumous assisted reproduction. Two situations are distinguished: cases in which the gametes or embryos are used by the surviving partner and cases in which the gametes or embryos are made available for third persons. The moral evaluation of the procedure depends on whether the act is restricted to the existing parental project. A major difficulty for the moral evaluation is the inconclusiveness of the empirical data on the psychosocial development of children born after this procedure. The Task Force concluded that posthumous reproduction by a partner is acceptable if the following conditions are met: written consent has been given by the deceased person, the partner received extensive counselling and a minimum waiting period of 1 year is imposed before a treatment can be started. For use by third parties, the usual conditions for gamete and embryo donation apply.

Posthumous Reproduction and the Presumption Against Consent in Cases of Death Caused by Sudden Trauma

The deceased's prior consent to posthumous reproduction is a common requirement in many common law jurisdictions. This paper critically evaluates four arguments advanced to justify the presumption against consent. It is argued that, in situations where death is caused by sudden trauma, not only is there inadequate justification for the presumption against consent, but there are good reasons to reverse the presumption. The article concludes that the precondition of prior consent may be inappropriate in these situations.

Legal Issues Related to Parenthood After Cancer

Cancer and procreation raise a host of novel legal issues involving the rights of those trying to create families after cancer treatment and any resulting children, as well as the responsibilities of those who assist them. Recent court decisions, although neither consistent nor plentiful, highlight the emerging legal issues for patients, providers, and offspring. This article explores a number of legal issues related to cancer and parenthood, including: 1) patients' cryopreservation of sperm, eggs, or embryos and subsequent access to and use by them or their former partners; 2) fertility preservation in minor patients; 3) posthumous reproduction and legal parentage issues for children born from cryopreserved embryos or gametes; 4) wrongful life or wrongful birth claims of children born following their parents' cancer treatments; 5) access to, and discrimination in, medical treatment or alternative family-building options; and 6) professional responsibility and liability for providers relating to the potential fertility impact of cancer treatment. The limited, evolving court decisions, through the application of legal principles such as negligence, malpractice, discrimination, and parentage principles, provide some guidance for patients, providers, and policymakers in approaching the unique challenges presented by fertility preservation in the context of cancer treatments.

Assisted reproduction practice: religious perspectives

It is important to those who practise reproductive techniques to learn about different religious perspectives related to reproductive health problems. Religious groups are active in influencing the public regarding bioethical positions, and this is particularly evident with issues concerning procreation, abortion and infertility therapy. The Jewish attitude towards procreation is derived from the first commandment of God to Adam to 'Be fruitful and multiply'. Judaism allows the practice of all techniques of assisted reproduction when the oocyte and spermatozoon originate from the wife and husband respectively. The attitude toward reproductive practice varies among Christian groups. While assisted reproduction is not accepted by the Vatican, it may be practised by Protestant, Anglican and other denominations. According to traditional Christian views, beginning at conception, the embryo has moral status as a human being, and thus most assisted reproductive technologies are forbidden. According to Islam, the procedures of IVF and embryo transfer are acceptable, although they can be performed only for husband and wife. Developments in science and technology and corresponding clinical applications raise new religious questions, often without clear answers. The role of theology in bioethics is integral to clarify perceived attitudes toward these developments for different religious communities. This paper presents the attitude of monotheistic religions to therapeutic procedures, such as IVF-embryo transfer, spermatozoa, oocytes, embryo donation, cryopreservation of genetic material, surrogacy, posthumous reproduction, gender preselection, reproductive and therapeutic cloning.

Woman wants dead fiancé's baby: who owns a dead man's sperm

The Brisbane Supreme Court has denied an Australian woman's request to harvest and freeze her dead fiancé's sperm for future impregnation. After she was denied access to the sperm, the woman learnt that her fiancé may have been a sperm donor and she began checking to find out if his sperm was still available. Given what we know, there is a good ethical argument that the woman should have access to the sperm and should be allowed to have her dead fiancé's child. Another aspect of this case is that it illustrates the way in which ethics, law, and personal opinion can differ.

Response to Orr and Siegler--collective intentionality and procreative desires: the permissible view on consent to posthumous conception

Orr and Siegler have recently defended a restrictive view concerning posthumous sperm retrieval and conception, which would limit insemination to those cases where the deceased man has provided explicit consent for such a procedure. The restrictive view dominates current law and practice. A permissible view, in contrast, would allow insemination and conception in all but those cases where the posthumous procedure has been explicitly refused, or where there is no reasonable evidence that the deceased person desired children. I describe a phenomenology of procreative desires which supports the permissible view, and which is compatible with requirements concerning the interests of the decedent, concepts of medical infertility, and the welfare of the future child. The account illustrates how our current obsession with individual rights and autonomy can be self-defeating and repressive.

[Posthumous sperm procurement and use--ethical and legal dilemmas]

OBJECTIVE

To present a review of bioethical discussion and recommendations concerning posthumous sperm procurement and postmortem parenthood.

DESIGN

Review article.

SETTING

Department of Obstetrics and Gynecology, Masaryk University, Brno, Department of Obstetrics and Gynecology, Palacky University, Olomouc.

SUBJECT AND METHOD

Literature search in Database of Abstracts of Reviews of the Evidence (DARE) and MEDLINEplus. Posthumous sperm procurement and cryopreservation must be performed within 36 hours after death. To established appropriate medical practice, it is important to consider all stakeholders in the decision-making process: the deceased, the requesting party, the child, the physician and the society. There are only few legislative measures concerning postmortem parenthood and posthumous sperm procurement. The essential elements for postmortem reproduction are: judicial order, ethics committee approval, bereavement period of at least 6 month before use.

CONCLUSION

Posthumous sperm procurement is fraught with ethical and legal implications. All stakeholder should be considered. Society for reproductive medicine should prepare acceptable standard protocol.