Single men's attitudes towards posthumous use of their sperm cryopreserved due to illness in Israel.

BACKGROUND: Banking of frozen spermatozoa by single men opens the possibility of procreation long after their death. Requests for posthumous reproduction by the families of the deceased are growing, raising an ethical debate, especially when written instructions were not left by the patients and in cases of unplanned perimortem collection. The issue of the progenitors' intention to procreate after death is the key to ethically based decision-making in these cases. OBJECTIVES: To evaluate the attitude of single men cryopreserving spermatozoa before life-threatening medical situations towards post-mortem usage of their cryopreserved spermatozoa. MATERIALS & METHODS: Adult single men prior to sperm cryopreservation before cytotoxic therapy were asked to sign a structured form declaring their will and instructions for the usage of their cryopreserved spermatozoa in case of their demise. RESULTS: Four hundred fifty-two men of diverse ethnicity, religious and cultural backgrounds signed the form providing instructions for the use of their cryopreserved spermatozoa in case of mortality. Their age was 27.4 ± 8.06 years. Seven (1.5%) patients willed their spermatozoa for posthumous reproduction to a sibling, 22 (4.9%) to parents, and 26 (5.7%) to their informal female partners. The significant majority (n = 397; 87.8 %) of the single men were ordered to destroy their cryopreserved spermatozoa in case of their expiry. Note that, 26-39 years old men were less likely (81.8% vs. >90% in other ages) to order sperm destruction, as well as men with a poorer prognosis (83% vs. 90%). DISCUSSION: In this study group, most single men cryopreserving spermatozoa in the face of future life-threatening morbidity do so for their own future live parenthood, and are not interested in posthumous reproduction. CONCLUSION: Our results doubt the claim that single men who had an unplanned perimortem sperm collection can be universally presumed to have wished to father a child posthumously. Any claimed assumed consent in these cases should be considered for each case individually based on its specific circumstances.

Ethical and Practical Considerations of Perimortem Gamete Procurement for Palliative Care Providers.

Requests for perimortem gamete procurement (PGP) typically arise by a surrogate decision maker after the unexpected death or incapacitation of a reproductive-aged individual. Palliative care clinicians should have a working knowledge of the medical, ethical, and practical considerations pertaining to such requests. In this paper, we describe a case in which the PGP request originated from an incapacitated patient's parents. We review the technologies associated with PGP and posthumous assisted reproduction (PAR) and discuss the ethical and legal issues involved in such cases, including recent position statements from national and international reproductive health groups. Finally, we provider readers with a stepwise approach for considering requests for PGP.

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.

Perspectives surrounding fertility preservation and posthumous reproduction for adolescent and young adults with terminal cancer: Survey of allied health professionals.

BACKGROUND: While all reproductive-aged individuals with cancer should be offered fertility preservation (FP) counseling, there is little guidance over offers to adolescent and young adults (AYA) with terminal diagnoses, especially when considering posthumous assisted reproduction (PAR). The Enriching Communication skills for Health professionals in Oncofertility (ECHO/ENRICH) trains Allied Health Professionals (AHPs) to improve communication with AYAs with cancer. Little is known about AHPs' role in assisting in FP and PAR decisions. METHODS: This is a cross-sectional survey of ECHO/ENRICH trainees' attitudes and experience with FP and PAR in AYA with terminal cancer. RESULTS: The response rate was 61% (365/601). While 69% felt comfortable discussing FP with terminal AYA after ECHO/ENRICH training, 85% desired further education. The majority (88%) agreed FP should be an option for AYA with cancer, though some agreed offering FP provided false hope (16%) or was a waste of resources (7%). Most shared that avoidance of FP discussions was common practice, especially in the medically fragile, late-stage disease, or among minors. Many attributed lack of conversations to oncology team goals. Only 9% had prior experience with PAR. Many were conflicted about how PAR reproductive material should be gifted and who should be permitted to use PAR. Several raised moral concerns for PAR, or discomfort advising family. Many voiced desire for additional PAR-specific education. CONCLUSION: ECHO/ENRICH trainees had varied levels of exposure to FP in terminal AYA and limited experiences with PAR. Many expressed uncertainties with PAR, which may be alleviated with further training and transparent institutional policies.

Regulación legal de la fecundación asistida post mortem en España / Legal regulation of assisted post-mortem fertilisation in Spain

El avance en las técnicas de reproducción humana asistida ha hecho posible que el fallecimiento de una persona ya no necesariamente derive en el fracaso de su proyecto parental. La regulación de la fecundación post mortem en España es poco profusa, deja vacíos legales y posibilita interpretaciones diversas. Pese a ello, resulta posible establecer la filiación paterna a favor del hijo póstumo con los efectos legales que lleva aparejada la filiación. (AU)

Advances in assisted human reproduction techniques have made it possible that thedeath of a person no longer necessarily results in the failure of his parental project. The regulation of post-mortem fertilisation in Spain is not very profuse, leaves legal gaps and allows for different interpretations. Despite this, it is possible to establish paternal filiation in favour of the posthumous child with the legal effects that filiation entails. (AU)

Inseminação artificial homóloga póstuma: análise bioética do planejamento familiar / Posthumous homologous artificial insemination: a bioethical analysis of family planning / Inseminación artificial homóloga póstuma: un análisis bioético de la planificación familiar

Resumo Este artigo trata de questões relacionadas à inseminação artificial homóloga post mortem. Tomando como referência normas éticas que asseguram a livre escolha do casal no planejamento familiar, objetivou-se descobrir de que forma tais regulamentações influenciariam na concretização desse projeto parental. A partir do método hipotético-dedutivo, realizou-se revisão de literatura em bioética e biodireito, além de pesquisa documental no sítio eletrônico do Conselho Federal de Medicina. Refletiu-se, então, sobre o princípio de autonomia dos pacientes submetidos às técnicas de reprodução assistida, levando em conta algumas das repercussões dessa técnica sobre o direito de família e sucessões. Por fim, descreveu-se o método de casuística clínica, utilizado pelas clínicas como parâmetro para tomar decisões e aconselhar o cônjuge sobrevivente acerca da problemática da concepção póstuma.

Abstract This article discusses issues related to post mortem homologous artificial insemination. Taking as reference ethical norms that ensure the couple's free choice in family planning, the objective was to understand how such regulations would influence the accomplishment of this parental project. Using the hypothetical-deductive method, a literature review on bioethics and biolaw was carried out, in addition to a documentary research on the website of the Federal Council of Medicine. Then, reflections on the principle of autonomy of patients undergoing assisted reproduction techniques were made, considering some of the repercussions of this technique on family and succession law. Finally, a description of the method of clinical casuistry is presented, being used by clinics as a parameter to make decisions and advise the surviving spouse about the problem of posthumous conception.

Resumen Este artículo trata aspectos relacionados a la inseminación artificial homóloga post mortem. Con base en la normativa ética que garantiza la libre elección de la pareja en la planificación familiar, el objetivo fue identificar la influencia de la legislación en la realización de este proyecto parental. A partir del método hipotético-deductivo, se realizó una revisión bibliográfica sobre bioética y bioderecho, además de una búsqueda documental en el sitio web del Consejo Federal de Medicina. Con esto, se reflexionó sobre el principio de autonomía de los pacientes sometidos a técnicas de reproducción asistida, teniendo en cuenta algunas de las repercusiones de esta técnica en el derecho de familia y de sucesiones. Por último, se describió el método de la casuística clínica utilizado por las clínicas como parámetro en la toma de decisiones y asesoramiento al cónyuge sobreviviente en el tema de la concepción póstuma.

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.

Posthumous sperm retrieval: a procreative revolution.

Aim Postmortem sperm retrieval with consequent artificial insemination has become a technically possible option for future use in assisted reproductive technology (ART). The authors have set out to discuss the social and ethical significance of posthumous sperm retrieval, and the laws currently in force in Italy, the United States and elsewhere. Methods International literature from 1997 to 2020 has been reviewed from Pubmed database, Google Scholar and Scopus, drawn upon American, Italian and international sources (an ethically acceptable solution can only be achieved through an overhaul of the laws currently in effect). One of the most contentious issues was about donor consent. In Italy, a donor's will to retrieve his sperm in the event of premature disappearance can be proven according to the Law 219/2017, through advance health care directives. Results A substantial increase, both in requests and protocols, was documented in the United States. In Italy, over the last two years, three rulings were issued concerning posthumous insemination. However, no official standardized protocols, guidelines or targeted legislation exist at the national level to regulate medical activity in that realm, whereas established laws often set implicit limitations. Conclusion Current legal frameworks appear to be inadequate, because in most cases they were conceived under conditions that have radically changed. The need for newly-updated regulatory frameworks to promptly bridge that gap is increasingly clear, if current social needs related to reproductive rights are to be met in the foreseeable future.

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.

Consentimiento presunto a las técnicas de reproducción humana asistida post mortem. Criterios para su regulación en Argentina / Presumed Consent to Posthumous Assisted Human Reproduction Techniques. Principles for its Regulation in Argentina / Consentiment presumpte a les tècniques de reproducció humana assistida post mortem. Criteris per a la seva regulació a l'Argentina

Este artículo propone criterios para la regulación del consentimiento presunto a las técnicas de reproducción humana asistida post mortem en Argentina y argumenta brevemente sobre los fundamentos del instituto. Si bien el Código Civil y Comercial de la Nación prevé un sistema autónomo de filiación aplicable a las tecnologías reproductivas, los casos post mortem han sido desregulados. En los últimos años se han dictado numerosas sentencias que han reconocido el consentimiento presunto del difunto, aunque sin una construcción conceptual clara al respecto y con la consecuente inseguridad jurídica en torno a la filiación de las personas nacidas

This article proposes principles for the regulation of presumed consent to posthumous assisted human reproduction techniques in Argentina and argues about the basis of that institute. Although the Civil and Commercial Code of the Nation provides an autonomous filiation system applicable to reproductive technologies, posthumous cases have not been regulated. In recent years, several judgments have recognized the presumed consent of the deceased, although without a clear conceptual construction and with the consequent legal uncertainty regarding the filiation of the persons born

Aquest article proposa criteris per a la regulació del consentiment presumpte a les tècniques de reproducció humana assistida post mortem a l'Argentina i argumenta breument sobre el fonament de l'institut. Si bé el Codi Civil i Comercial de la Nació preveu un sistema autònom de filiació aplicable a les tecnologies reproductives, els casos post mortem no han estat regulats. En els últims anys s'han dictat diverses sentències que han reconegut el consentiment presumpte de la persona morta, encara que sense una construcció conceptual clara sobre aquest tema i amb la conseqüent inseguretat jurídica entorn de la filiació de les persones nascudes

[Thoughts on the revision of the bioethics law in the field of assisted reproductive technologies (ART). The end of a conceptual framework?] / Réflexions autour de la révision de la loi bioéthique dans le domaine de l'assistance médicale à la procréation - Une rupture du cadre conceptuel ?

This contribution aims at analysing and presenting a comparative dimension concerning the issues raised for the upcoming French Bioethics law revision in the field of assisted reproductive technologies (ART) : access of female same-sex couples and single women to ART ; the authorization of post-mortem procreation ; enlarging eligibility criteria for oocyte self-conservation ; and lifting the anonymity of gamete donation. These questions touch at the very heart of the French bioethics model conceived in 1994, and their revision would constitute a conceptual upheaval.