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ASRM ethics chair on posthumous gamete retrieval
Society is revising its ethics policy
Recent reports that a Texas woman had her son's sperm retrieved following his unexpected death made headlines, while the American Society of Reproductive Medicine (ASRM) is in the process of updating its ethics policy on "posthumous donation" of germ cells using either eggs or sperm.
The only similar situation that is covered by the Birmingham, AL-based organization's current position paper revolves generally around when there is an unexpected death in a relationship, although that relationship typically is with a spouse or partner, says John Brzyski, MD, PhD, chair of the ASRM's ethics committee and professor and chief, division of reproductive endocrinology and infertility, University of Texas Health Sciences Center at San Antonio.
In its position paper, the committee notes that while posthumous births have been recognized since antiquity, posthumous reproduction, on the other hand, "first became possible only after semen could be frozen and used for artificial insemination after the donor was deceased."1
The paper also notes that in the United States: "The legal and social status of a child born from these origins has been ambiguous at best, even if the insemination and pregnancy occur with the wife of the dead man. Since the role of assisted reproduction had not been well factored into common law or social and ethical judgments, a child born from conception and pregnancy after a man's death may not always be attributed to him for purposes of inheritance and legitimacy.1
While the technology might consist of "only the commonplace cryopreservation of the sperm and insemination . . ., the social issues are complex," the position paper states.
This request for reproduction after death sometimes occurs when his spouse or partner requests to have the man's sperm frozen and used for conception in the event of his death. The same is true for men and their partners in the event the man has to undergo radiation or chemotherapy, and his partner or spouse requests gamete retrieval prior to the treatment for possible reproduction later.
Some country norms exist
In Israel, for example, Brzyski points out that widows are supported legally in that country in any efforts to obtain posthumous gametes, "because the focus there is very pro-natal, pro-life" and on expanding child-bearing in that society. That contrasts with the United Kingdom, where, without written authorization provided by the person while he was alive, posthumous reproduction would be considered "unacceptable use."
The roots of the United States, he notes, are in the UK, which tends to view individual autonomy and self-determination as more important than "social goals."
In the United States, he says, "this scenario is imagined where there's not written consent and there's been a case made by the surviving partner that this is a goal of theirs, and she wishes to pursue it. And so, once a person has passed away, what exactly are their rights?"
But that is answered by the scenarios where people have wills and other arrangements "that indicate that there's certain social conventions of respecting the wishes of individuals even after they're gone, in terms of the legal arena," he says.
But the situation reported more recently regarding the mother who wished to become a grandmother using her son's sperm retrieved after his death, Brzyski says, is a different situation.
"I think most people would recognize that and be less supportive of the ethical foundation for the claims of the mother," Brzyski says.
The missing link
"Part of the foundation of ethical discernment and decisions you are making rests on human experience. That's the missing link; where you don't have a human experience, it's hard to make judgments on any sound basis," Brzyski says.
Even though most people think of ethics as rooted in philosophy, he notes that ethics is also "founded on observations, and that does sort of go into the calculus."
The institution where Brzyski practices decides cases of this nature on a case-by-case basis "based on the circumstances of the situation," he says.
"I think the thing that I personally feel comfortable supporting is the collection of the gametes, because that is a very time-sensitive issue," he notes. "So, I might, in the appropriate circumstances, be supportive of collecting the gametes, but I'd be more cautious about I would be in no hurry to utilize those."
He says when death is involved, there is a grieving process that has to be worked though.
"You don't want to have the surviving partner make decisions rashly when they are dealing with the acute experience of their loss," he says.
Brzyski recommends referring the surviving partner to a mental health professional to help discern that person's values, goals, and objectives in life and how loss can influence decision-making.
He also supports having such cases come before the full ethics committee.
"It's always helpful to get a disinterested group of individuals together . . . to sort of reinforce the thought processes of the individuals involved in the case," he notes.
John Brzyski, MD, PhD, Chair of the American Society for Reproduction's Ethics Committee; Professor and Chief, Division of Reproductive Endocrinology and Infertility, University of Texas Health Sciences Center at San Antonio. E-mail: email@example.com.