A content analysis of posthumous sperm procurement protocols with considerations for developing an institutional policy
Stanford Center for Biomedical Ethics, Stanford University, Stanford, California. Electronic address: . Fertility and sterility
(Impact Factor: 4.59).
06/2013; 100(3). DOI: 10.1016/j.fertnstert.2013.05.002
OBJECTIVE: To identify and analyze existing posthumous sperm procurement (PSP) protocols in order to outline central themes for institutions to consider when developing future policies. DESIGN: Qualitative content analysis. SETTING: Large academic institutions across the United States. PATIENT(S): N/A. INTERVENTION(S): We performed a literature search and contacted 40 institutions to obtain nine full PSP protocols. We then performed a content analysis on these policies to identify major themes and factors to consider when developing a PSP protocol. MAIN OUTCOME MEASURE(S): Presence of a PSP policy. RESULT(S): We identified six components of a thorough PSP protocol: Standard of Evidence, Terms of Eligibility, Sperm Designee, Restrictions on Use in Reproduction, Logistics, and Contraindications. We also identified two different approaches to policy structure. In the Limited Role approach, institutions have stricter consent requirements and limit their involvement to the time of procurement. In the Family-Centered approach, substituted judgment is permitted but a mandatory wait period is enforced before sperm use in reproduction. CONCLUSION(S): Institutions seeking to implement a PSP protocol will benefit from considering the six major building blocks of a thorough protocol and where they would like to fall on the spectrum from a Limited Role to a Family-Centered approach.
Available from: Ligiane A Machado-Paula
- "According to Batzer et al. (2003), a number of countries have a formal regulatory policy, while others do not, and as the number of requests for these procedures increases, we have to prepare ourselves ethically and legally for this situation. Bahm et al. (2013) analyzed existing protocols of PMRS in the USA and provided six important considerations to help institutions to develop an institutional policy regarding this issue with practice guidelines protecting institutional and individual liability. "
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ABSTRACT: Postmortem sperm retrieval has been used worldwide in assisted reproduction technology. Nevertheless, the laws vary from country to country according to cultural, ethical and religious reasons. However, for postmortem sperm re-trieval to be used, it is necessary that a preview informed consent be signed by the couple. In this study, we de-scribe a case where the husband died during the in vitro fertilization (IVF) treatment prior to egg retrieval, but we had no informed consent with a paragraph concerning this issue. Thus, the wife had to request a judicial authoriza-tion, which was given in the case of an emergency by the judge, to retrieve genetic material from her husband after his sudden death. This case report demonstrates the im-portance of adding a specific paragraph in the informed consent to address this issue. Otherwise, this case may be a cause of a judicial battle to obtain consent for its use in in vitro fertilization.
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ABSTRACT: Conception of a child using cryopreserved sperm from a deceased man is generally considered ethically sound provided explicit consent for its use has been made, thereby protecting the man's autonomy. When death is sudden (trauma, unexpected illness), explicit consent is not possible, thereby preventing posthumous sperm procurement (PSP) and conception according to current European Society of Human Reproduction and Embryology and the American Society for Reproductive Medicine guidelines. Here, we argue that autonomy of a deceased person should not be considered the paramount ethical concern, but rather consideration of the welfare of the living (widow and prospective child) should be the primary focus. Posthumous conception can bring significant advantages to the widow and her resulting child, with most men supporting such practice. We suggest that a deceased man can benefit from posthumous conception (continuation of his ‘bloodline’, allowing his widow's wishes for a child to be satisfied), and has a moral duty to allow his widow access to his sperm, if she so wishes, unless he clearly indicated that he did not want children when alive. We outline the arguments favouring presumed consent over implied or proxy consent, plus practical considerations for recording men's wishes to opt-out of posthumous conception.
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