Policy on Posthumous Sperm Retrieval: Survey of 75 Major Academic Medical Centers.

OBJECTIVE: To evaluate the presence and content of policies on posthumous sperm retrieval at 75 major academic medical centers in the U.S. MATERIALS AND METHODS: We surveyed the top 75 major academic medical centers ranked for research in 2016 by U.S. News & World Report using a questionnaire-based telephone/web survey. We gathered data on the presence and content of posthumous sperm retrieval policies on the Internet. If not published, we contacted the legal counsel, the ethics and compliance offices, the urology department, as well as the infertility treatment center associated with each institution. In addition, we also surveyed members of the Society for Male Reproduction and Urology. RESULTS: We gathered data regarding posthumous sperm retrieval from 41 out of the 75 major academic medical centers. Of the 41 institutions, only 11 (26.8%) had policies regarding posthumous sperm retrieval. Out of those 11 centers, 4 required prior written consent, whereas the remaining 6 allowed for verbal or inferred consent from the surviving life partner. One policy prohibited the procedure. Five of the policies in this survey included a bereavement period. Of the 30 (73.2%) centers without policies, lack of legal guidance was cited as the most common barrier to policy adoption. CONCLUSION: Only a small proportion of major academic medical centers have policies on posthumous sperm retrieval. Medical centers can adopt individualized policies based on guidelines published by professional societies.

"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.

Posthumous Reproduction (PHR) in Israel: Policy Rationales Versus Lay People's Concerns, a Preliminary Study.

Israeli policy concerning PHR has been decided upon in an expertocratic manner, leaving the voice of the public unheard. Based on 26 semi-structured in-depth interviews with 13 Jewish-Israeli young couples, this preliminary study provides the first empirical data regarding lay attitudes toward PHR in Israel. Findings suggest major dissimilarities between the policy and lay people's wishes and rationales. While policy is built on the "presumed wish" assumption, supposing all men living in a loving relationship wish to have their partner carry their child post-mortem, this was empirically unsupported. However, the findings suggest that many interviewees were willing to defer to their surviving spouse's wishes to have their post-mortem child, sometimes even against their own wish, indicating a support for presumed consent. Respecting the wishes of the dead, a dominant argument in the bioethical discussion in Israel and beyond, was mainly irrelevant to informants, whereas interviewees considered the future child's welfare, a concern overlooked by Israeli policy. Likewise, while posthumous grandparenthood is on the rise in Israel, it clearly contradicts the wishes of the majority of this study's informants. Nonetheless, existing policy is not expected to raise any opposition, due to the extreme liberalism of the participants and their support of reproductive autonomy.

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.

[A comparison of reproductive rights in Europe: a right to reproduce?]. / Droit comparé en santé de la reproduction: un droit a se reproduire? Une vision européenne.

This article discusses the meaning of reproductive rights, and European attitudes to this issue, from both the ethical and legal standpoints. There is a difference in the international nomenclature between "reproductive rights "and a "right to reproduce", which translates in medical practice into a right to fertility treatment. Major national differences are outlined, particularly between France and the UK. Finally, the new phenomenon of cross-border reproductive care, a direct consequence of different national interpretations of reproductive rights, is discussed.

Nationwide use of postmortem retrieved sperm in Israel: a follow-up report.

A follow-up study of the subsequent use of all postmortem frozen sperm samples during 2003-2010 is reported. Only the sister of one of the 10 unmarried deceased men was in contact with the bank. Four widows elected to discard the frozen sperm and all of the remaining spouses were uninterested in its fate. Because none of the samples were requested for use, the need for sperm procurement should be reconsidered.

Present state of reproductive medicine in Japan - ethical issues with a focus on those seen in court cases.

BACKGROUND: Against a background of on the one hand, a declining demography and a conservative family register system that emphasizes the importance of the blood line, and on the other hand, an increase in the number of people undergoing fertility treatment, the absence of a legal regulatory framework concerning ART matters is likely to result in an increasing number of contradictory situations. It is against this background that the paper sets out to examine the judgements of court cases related to ART, with a particular focus on the legal determination of parental status, and to link these to aspects of the legal and socio-ethical environment within which the courts make their judgements. METHODS: The methods used were thorough investigation of all the court cases concerning ART in the public domain in Japan, including the arguments of the concerned parties and the judgements so far delivered. With the court cases as a central focal point, trends in Japan, including deliberations by government and academic societies, are reviewed, and the findings of surveys on the degree of understanding and attitudes among the people toward ART are summarized. RESULTS: In terms of the judgements to date, the central criteria used by the courts in determining parental status were the act of parturition and the consent of the husband of the concerned couple. The government and academic societies have displayed a cautious attitude toward ART, but the findings of attitude surveys among the people at large show a generally positive attitude toward ART. Attitudes toward the overwhelming importance hitherto attached to the bloodline are also seen to be changing. CONCLUSION: The main conclusion is that in the absence of a legal regulatory framework for ART, there is likely to be an increase in the contradictions between the use of outdated legal precedents and the technical development of ART. Since much of the specialist discussion necessary for the formulation of a legal framework has already been carried out, the speedy enactment of comprehensive and at the same time flexible legislation would be highly desirable, but further wide-ranging discussion involving the general public is likely to be needed first.

Where does a man stand on issues of assisted reproduction, surrogacy, artificial insemination within lesbian relationships and posthumous conception?

This article takes issues more commonly associated with women: assisted reproduction, surrogacy, artificial insemination within lesbian relationships and posthumous conception and considers what role a man may play in this domain. To this end the article commences with a short scenario of possible life events then traverses the current legal position to examine the extent that the law either facilitates or frustrates a man's desire and ability to fulfill the role of either father or parent in the above situations. The article considers the issues of assisted reproduction technology in both a regulated and an unregulated environment.

Woodward v. Commissioner of Social Security.

KIE: Court Decision: 760 North Eastern Reporter, 2d Series 257; 2002 Jan 2 (date of decision). The Supreme Judicial Court of Massachusetts held that the plaintiff's children could inherit from their deceased father if they were shown to be genetically related to the decedent and if the plaintiff could show that the posthumously conceived children were conceived with her late husband's affirmative consent to reproduce and to support the resulting child. Upon learning he had leukemia, plaintiff Lauren Woodward's husband of over three years decided to bank his sperm. Mr. Woodward's cancer treatment was not successful and he died in October 1993. Two years later, in October 1995, the plaintiff gave birth to twin girls conceived through artificial insemination using her deceased husband's sperm. The United States District Court for the District of Massachusetts certified the question of the posthumously conceived children's inheritance rights to the Supreme Judicial Court of Massachusetts. The Supreme Judicial Court held that because death dissolves a marriage, posthumously conceived children are nonmarital children. As such, the genetic paternity of posthumously conceived children is a necessary prerequisite for inheritance. Secondly, in recognition of an individual's protected right to control the use of his gametes, the prospective donor parent "must clearly and unequivocally consent not only to posthumous reproduction but also to the support of any resulting child."^ieng

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.

Access to donor insemination: Canadian ideals--UK law and practice.

Reproductive technology has made a huge impact on society, exposing many long-standing, unresolved anomalies in our values and traditions. Access to medically assisted reproduction is particularly controversial, raising medical, legal and ethical issues. The 1980s saw increasing demands across several jurisdictions for clear legal rules, the hope being expressed in Canada that "the law may reflect the community's level of tolerance; but...also stretch or fashion it in the interests of a worthy goal." The Canadian Law Reform Commission recommended that, with regard to donor insemination, "protection for the traditional family should not be incorporated in legislation" and that "access should be limited only in terms of the cost and scarcity of resources", selection not being based on "family status, sexual orientation and so on". This paper attempts a comparative examination of UK legislation on reproductive technology in this light, with particular focus on the rationing of access to donor insemination.