Occasionally, patients request that family members be used as egg donors or gestational surrogates. This issue was addressed in a recently updated position paper from the Ethics Committee of the American Society for Reproductive Medicine (ASRM).1
“The ethical considerations surrounding intrafamilial gamete donation and gestational surrogacy focus on the well-being of those who offer to provide reproductive services, those who receive those services, and the offspring born of any such donation,” says Judith Daar, JD, chair of ASRM’s ethics committee. Daar also is clinical professor of medicine at University of California, Irvine School of Medicine.
The position paper states that:
- use of adult intrafamilial gamete donors and gestational surrogates is generally ethically acceptable when all participants are fully informed and counseled, but consanguineous arrangements or ones that simulate incestuous unions should be prohibited;
- adult child-to-parent arrangements require caution in order to avoid coercion;
- parent-to-adult child arrangements are acceptable in limited situations.
“Concerns that inure specifically to familial gamete donors and gestational carriers cluster around the principle of autonomy,” says Daar.
It is essential that an individual’s participation as a reproductive collaborator be fully informed, unconditionally voluntary, and not the result of coercion or undue influence by the intended parent or other party.
“Our opinion recognizes the potential and unique risk associated with reproductive family dynamics, and strives to help avoid these risks by setting out clear parameters as to the acceptability of various configurations as well as guidance for promoting informed consent,” says Daar.
The committee also considered the effect of intrafamilial donation and surrogacy on the resulting child. Several ethical concerns are highlighted.
“First, as in any donor-conceived or surrogacy scenario, the issue
of disclosure arises,” says Daar.
Family collaborations can involve heightened concerns about disclosure for the donor or surrogate, for that individual’s own offspring, or because of the impression of incest or consanguinity that can arise. Additionally, the offspring’s relationships within the family can be affected as a result of the intrafamilial ART collaboration.
“To address these concerns, the committee recommends that providers take special care to address these and other potential conflicts before proceeding with the requested treatment protocol,” says Daar.
- Ethics committee of the American Society for Reproductive Medicine. Using family members as gamete donors or gestational carriers. Fertil Steril 2017; 107(5):1136-1142.
- Judith Daar, JD, Clinical Professor of Medicine, School of Medicine, University of California, Irvine. Phone: (714) 444-4141 ext. 113. Fax: (714) 444-0855. Email: firstname.lastname@example.org.