Parent-initiated posthumous-assisted reproduction revisited in light of the interest in genetic origins.

A rich literature in bioethics argues against the use of anonymous gamete donation in the name of the 'interest in knowing one's genetic origins'. This interest stems from medical as well as psychosocial and identity reasons. The term 'genealogical bewilderment' has been coined to express the predicament of those deprived of access to information about their origins. Another rich body of literature in bioethics discusses arguments for and against posthumous-assisted reproduction (PAR), with a recent focus on PAR that is initiated by the parents of a deceased man (rather than his partner). This paper revisits arguments against PAR, in light of arguments regarding the interest in knowing one's genetic origins. Limiting the discussion to the specific context of parent-initiated PAR (PIPAR), we argue that the use of cryopreserved sperm from a deceased identifiable man in the context of PIPAR may be ethically preferable when compared with the use of anonymous donor sperm, since it allows genealogical certainty, that is, giving the prospective child access to information about the identity, life story and ancestry of the genetic progenitor as well as genealogical embeddedness, that is, close relationship with extended family members.

Attitudes toward posthumous assisted reproduction in China: a multi-dimensional survey.

BACKGROUND: Professional legislation and ethics guidelines for posthumous assisted reproduction (PAR) are lacking in China. This study aims to measure the attitudes of the general public, IVF couples, and assisted reproductive technology (ART) practitioners toward PAR in China. METHODS: A multi-dimensional survey was designed, and electronic questionnaires were used. General demographic data, reproductive viewpoints, attitudes toward PAR, interactive ability to predict the partner's attitude toward PAR, and the legal attributes and rights to the disposal of posthumous embryos were evaluated. RESULTS: The study found that the traditional Chinese viewpoints of fertility had changed. The approval rates for PAR were 79.10%, 55.32%, and 58.89%, in the general public, IVF couples, and ART practitioners, respectively. Most participants agreed that the psychological well-being of offspring should be previously considered before making a PAR decision (81.84%, 73.61%, and 76.98%, respectively). Multivariable logistic regression analysis showed that age, marital status, and gender were common influencing factors, while occupation, religion, and pregnancy history showed no influence on support for PAR. Males and females showed similar predictive abilities for their partners' attitudes toward PAR (57.87% for males, 61.12% for females). Intracouple agreement analysis showed that the consistent rate of consistency in attitudes toward PAR was 65.28%. CONCLUSION: The findings suggested that the approval rate of PAR was relatively high in China. Legislation and ethics guidelines for PAR may be considered in China. The psychological well-being of offspring should be considered before the implementation of PAR. Due to the very large regional and demographic differences in China, investigation of a larger samples of participants is necessary.

This study is based on the dilemma of how to deal with the remaining frozen embryos when a family structure changes (such as the accidental death of one or both partners). In this research, we systematically investigated the basic attitudes of different groups toward PAR, the consistency and prediction accuracy of attitudes between couples and their ability to predict their partners' attitudes, and the balance between offspring well-being and reproduction through a multi-dimensional cross-sectional survey in China. Our study illustrated that the approval rates of PAR were relatively high among the public, IVF couples and ART practitioners. Couples' attitude prediction accuracy and the intercouple concordance were moderate. The psychological well-being of offspring should be considered before the implementation of PAR. Moreover, an appropriate legal policy or specialized guidance for PAR may be considered and published in China. This research provides some advice and evidence for medical professionals and policymakers regarding practice and policymaking related to PAR. We also believe that this manuscript is valuable and helpful for all the researchers who are interested in the posthumous reproduction, not only in China.

Posthumous Reproduction and the Law: Tissue Transplantation, Property Rights and the Reproductive Relational Autonomy.

This paper examines the history of Australian superior court decisions on the retrieval of gametic material from deceased men. It examines the history of case law and legislation on the issue and then provides a summary of the current operative principles. The paper concludes with some reflections on the harms caused by posthumous retrieval of gametes, the role of property rights and the nature of reproductive autonomy.

Children of the Dead: Posthumous Conception, Critical Interests and Consent.

Artificial Reproductive Technology now enables the conception of children after the death of their genetic father. There is little consensus on how posthumous conception should be dealt with by the law and this article examines alternative approaches to such regulation. The goal of any such regulatory regime should be the vindication of the deceased's critical or objective interests after death. Alternative approaches risk instrumentalising the dead to serve the interests of the living, or weigh too heavily the deceased's past decisional autonomy at the cost of respecting his or her likely wishes after death. Separate requirements should apply to applications for posthumous sperm retrieval and its subsequent use, with the former being less onerous given the emergency nature of the procedure and the latter involving a tribunal whose function is to consider how best to give effect to the deceased's reproductive autonomy after death.

Australia after Cresswell and Chapman: A Legal and Regulatory Paradox, or an Opportunity for Uniformity?

Australia, like many overseas jurisdictions, has recognised the need to cope with advancing medical technology and changing community attitudes towards assisted reproductive technology (ART). Despite this, several States in Australia still do not have legislative instruments regulating ART, and those that have legislated have done so in a non-uniform way. In 2018/2019, four cases came before State Supreme Courts, where the female applicants had to endure significant legal battle in order to utilise their late partner's gametes, highlighting the inability of the law to provide an appropriate clinical framework. This article outlines and discusses the current position of Australian States on the utilisation of posthumous gametes and how the recent decisions of the Supreme Courts of New South Wales, Queensland and Western Australia augment the current law and National Health and Medical Research Council Guidelines, and finally, considers how future legislation might account for the potential posthumous utilisation of oocytes.

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.

MEDICAL-LEGAL PROBLEMS OF INTERFERENCE IN THE RIGHT TO HUMAN AUTONOMY IN POSTMORTEM REPRODUCTION.

OBJECTIVE: The aim is a theoretical and methodological substantiation of revealing the possibility of interfering in the autonomy of a person during posthumous reproduction and establishing the existing protection of the rights and interests of postmortem children. PATIENTS AND METHODS: Materials and methods: The legislation of the European Union, the USA, Great Britain, New Zealand, Spain, Germany, Ukraine, the statistical data published by the internationalorganizations are analyzed. In the course of the research a systemic, axiological approach and methods of analysis, synthesis, generalization were used. CONCLUSION: Conclusions: It is proved that reproductive interference in the autonomy of the deceased in order to have a child is possible only on law basis, and in its absence - by a joint decision of the council of doctors, family lawyers, relatives of the deceased, taking into account the moral principles of society, public interests, rights and interests and other constituents (other heirs). It is emphasized that the origin of a postmortem child can be established based on a court decision. It is emphasized that post-mortem children should not have any discrimination; they are equal with other children. It was found that the system of rights of postmortem children includes personal non-property rights of a child (right to life, health, name, surname of biological parents); property rights (right to inheritance, right to social security). The primary is the system of non-property rights that ensure the physical and social life of the postmortem child.

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.

(Un) Natural Grief: Novelty, Tradition and Naturalization in Israeli Discourse on Posthumous Reproduction.

This article examines Israeli discourse on posthumous reproduction (PR) and the related cultural construction of "(un)natural" grief. Based mainly on an analysis of in-depth interviews with family members who submitted a request for PR, we examine the regimes of justification used by supporters and opponents of this technology. With both sides using the notion of "nature" to support their claim, the dispute centers on whether PR constructs a new social expression of grief (and hence should be seen as unnatural) or is only a reflection of an age-old grieving process (and is thus natural). We argue that by employing a twofold, novel/traditional justification, PR supporters aim to go one step further, from a symbolic continuity of the dead to a so-called real one. This progression highlights the flexibility of the natural category at the intersection of technology and culture and the abandonment of such binary distinctions as life/death and nature/culture.

Soldiers' Preferences Regarding Sperm Preservation, Posthumous Reproduction, and Attributes of a Potential "Posthumous Mother".

We present study results regarding soldiers' willingness to conduct posthumous reproduction. Two hundred twelve Israeli soldiers filled in a questionnaire designed to examine their willingness to cryopreserve sperm and evaluate in which familial circumstances they would consent to posthumous reproduction. They ranked the desirability of 46 attributes of a potential mother and a life partner. Findings indicate a relatively high predisposition in favor of posthumous-assisted reproduction; the wishes of soldiers' parents had much more influence on soldiers' willingness to pursue this technology than those of a partner. Soldiers preferred "feminine" jobs for a potential mother that would allow her to dedicate herself to child-rearing. The desired traits of such a mother were rated similarly to partner preferences; however, significant differences were found in attributes that are most related to the potential mother's devotion to maternity. Interpretations of these findings are contextualized in relation to ethical and bereavement considerations.

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).

Ethical Barriers in Adolescent Oncofertility Counseling.

Adult survivors of pediatric cancers are at substantial risk for infertility. Oncofertility is an emerging field in medicine that has focused on the fertility preservation of these patients. As the field continues to develop, there are several areas in which our practice has improved. However, several ethical concerns still exist involving beneficence, nonmaleficence, informed consent, adolescent assent, and posthumous use of reproductive tissues. Because the field is still developing, great disparities exist in available options depending on age, ability to pay, and geographic location. Such discrepancies in access may lead to health disparities in the adolescent patient population. As the science continues to make future fertility more feasible, the ethical questions will continue to be more complex. The purpose of this article is to review some of the developments regarding oncoferility and address future directions for research and inquiry in specific areas.

Mapping French people's views regarding posthumous reproduction.

OBJECTIVE: The study mapped French people's views regarding the acceptability of posthumous reproduction. BACKGROUND: Posthumous reproduction - the use of a deceased person's gametes for procreative purposes -is a controversial procedure because it involves a series of ethical issues, namely the surviving partner's rights to procreation, the emotional feelings and financial interests of other family members, and the government's interest in maintaining orderly inheritance rules. METHODS: A convenience sample of participants aged 19-68 (104 lay people, 47 health professionals and 15 lawyers) were presented with 48 realistic stories that were composed according to a four-factor within-subject design: marital status (married for about 10 years with children, married for about three years without children, and cohabiting for three years without children) × attitude of the deceased's parents (favourable vs. unfavourable to posthumous procreation) × time elapsed since the partner's death (three months vs. nine months) × deceased's wishes (written consent, oral consent given in front of credible witnesses, unknown wishes, and unfavourable attitude). RESULTS: Through cluster analysis, four qualitatively different positions were found. They were called Never Acceptable (35% of the sample, mostly health professionals, lawyers and regular attendees to the church or temple), Tolerable in a Few Cases (28%), Depends on Deceased's Wishes (22%, mostly lay people) and Quite Acceptable (16%, mostly lay people). CONCLUSIONS: About half of French lay people view the current legislation regarding posthumous assisted reproduction in a country such as the UK as more appropriate than the French legislation.

The Ethics of a Postmortem Testicular Harvest.

BACKGROUND: Faith and religion are topics that are not routinely discussed or of much significance in the emergency department (ED). However, there are certain cases when faith or religion can cause certain ethical dilemmas for the physician, patient, or hospital. Understanding patients' beliefs affects our own medical decision-making and the ability to treat certain illnesses. Hospital policy or religious views of the hospital can affect patient management. Spirituality or religion in the ED will not be an issue with every patient; however, there are times where religious beliefs will be at the very center of an ED visit, as shown by this case report. CASE REPORT: A 42-year-old man presented to the ED in cardiac arrest. Despite resuscitation and appropriate advanced cardiac life support, he was pronounced dead in the ED. The patient's wife stated they were trying to have a child and requested testicular harvest, planning for in vitro fertilization. Being at a Catholic institution, this raised important ethical questions. After the involvement of several disciplines, a resolution was reached that placated the patient's wife and the hospital. CONCLUSION: This report highlights the importance of understanding the ethical questions raised from faith-based issues in the ED to be able to provide the highest level of patient-centered care.

Blurring the line between life and death: a review of the psychological and ethical concerns related to posthumous-assisted reproduction.

Posthumous-assisted reproduction (PAR), though viewed unfavourably by some, is desirable to many individuals whose partners die prior to the completion of family building. PAR is technically feasible for males and females both pre- and post-mortem and these procedures have previously been completed on numerous occasions. However, such treatment is associated with three primary ethical concerns: autonomy; beneficence; and justice for the living, the deceased, and the soon-to-be conceived. Further, there are many psychological risks of PAR which may affect all involved parties. As such, early psychological counselling of patients and surviving family members is warranted.

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: 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.