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.

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.

Posthumous retrieval and use of gametes or embryos: an Ethics Committee opinion.

Posthumous gamete (sperm or oocyte) retrieval or use for reproductive purposes is ethically justifiable if written documentation from the deceased authorizing the procedure is available. Retrieval of sperm or eggs does not commit a center to their later use for reproduction, but may be permissible under the circumstances outlined in this opinion. Embryo use is also justifiable with such documentation. In the absence of written documentation from the decedent, programs open to considering requests for posthumous use of embryos or gametes should only do so when such requests are initiated by the surviving spouse or partner. This document replaces the report of the same name, last published in 2012.

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.

"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 gamete retrieval and reproduction: would the deceased spouse consent?

Policy and medical decision-making has been hindered by the absence of reliable data on attitudes toward having one's own gametes retrieved posthumously and used to produce a child in the event of an untimely death. The purpose of this study is to directly and empirically examine whether the presumption against consent is justified in the case of posthumous gamete retrieval following sudden death. Respondents (N=2064) were contacted using a random-digit dialing method that gave every household telephone in the continental United States an equal probability of being contacted, and were asked: "Suppose you were to experience an early death and your spouse wanted to have a biological child with you. Would you or would you not want your spouse to be able to use your sperm/eggs following your death to have a child with you?" Among reproductive age respondents (18-44 years), 70% of males and 58% of females wanted their spouse to be able to use their gametes and, for the most part, attitudes were fairly consistent across demographic characteristics. Religiosity was the best predictor of attitudes--those who described themselves as more religious were less likely to desire posthumous gamete retrieval--but the majority (58%) of respondents who were very religious approved of retrieval. Overall, these data indicate that abandoning the prevailing presumption against consent in favor of a presumption of consent on the part of the deceased will result in the deceased's wishes being honored two and three times more often for females and males, respectively. Three main arguments against a presumption of consent in this context are discussed: autonomy of the deceased, conflict of interest, and the decision-making capacity of a grieving spouse.

Attitudes toward making babies with a deceased partner's cryopreserved gametes.

A multiple segment factorial vignette was used with a probability sample of 857 U.S. households to assess the effects of contextual variables on attitudes toward posthumous reproduction using the cryopreserved gametes of a deceased partner. Attitudes were affected in predictable directions by marital status, gender of the deceased individual, disposition of the deceased's parents, and the deceased's wishes. In addition, respondents who identified more closely with their chosen religion tended to perceive posthumous conception as less appropriate and those who had never had children attributed a greater degree of obligation to assist on the part of medical professionals.

Posthumous assisted reproduction: a survey of attitudes of couples seeking fertility treatment and the degree of agreement between intimate partners.

OBJECTIVE: To study attitudes about posthumous assisted reproduction (PAR) in individuals presenting for assisted reproduction, to examine the degree of concordance of attitudes within couples, and to determine whether individuals can accurately predict the attitudes of their intimate partners. DESIGN: Cross sectional survey. SETTING: University-based fertility center. PATIENT(S): One hundred six couples presenting for an initial fertility evaluation. INTERVENTION(S): Anonymous survey completed independently by each partner. MAIN OUTCOME MEASURE(S): 1) individual attitudes about PAR, 2) the rate of concordance in attitudes within couples, and 3) the ability of individuals to predict their partner's attitudes. RESULT(S): Approximately 78% of individuals stated they would permit PAR. Couples expressed concordant attitudes about 75% of the time. Statistically, women and men were equivalent in correctly predicting their partner's attitudes (79% vs. 71%). CONCLUSION(S): Although most individuals presenting for fertility treatment would agree to PAR, there was also a notable portion that stated that they would not consent with the process. Although most couples had concordant attitudes, discordance was also prevalent. Individuals often, but not always, were able to predict their partner's attitudes about PAR.

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.

Study of views on posthumous reproduction, focusing on its relation with views on family and religion in modern Japan.

Posthumous reproduction has been performed in Japan several times, without sufficient civic discussion on its appropriateness or legislative regulation. There have even been several lawsuits on posthumous acknowledgment (in which a baby born to a deceased father has the same birthright as a baby born to a living father), and some judgments have proposed the need to develop societal agreement on posthumous reproduction and suggested legislative settlement. With this background, this study aims to clarify the views of the Japanese people regarding posthumous reproduction. In December 2007, we distributed a questionnaire on posthumous reproduction in relation to beliefs about family and religion to 32 universities across the country, and received 3,719 replies. It was found that about 60% of respondents agreed with posthumous reproduction. Statistical analysis was applied to the relationship between this overall position on posthumous reproduction and views on assisted reproduction technologies, family, religion, and so on. The degree of support for posthumous reproduction was strongly correlated with the degree of affirmation of assisted reproduction technologies and a liberal worldview with emphasis on self-determination. On the other hand, there was also a strong correlation with having a traditional view of family, such as family succession. The degree of support for posthumous reproduction was also highly correlated with the intimacy among family members, underlying which was a strong connection to the traditional religious belief in Japan that deceased family members watch the living ones. The view on posthumous reproduction is culturally complex and cannot be explained by a simple dichotomy between traditional conservatives and liberals.

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.