American Attitudes in Context: Posthumous Sperm Retrieval and Reproduction

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J Clinic Res Bioeth Ethics: Reproductive Technologies ISSN: 2155-9627 JCRB, an open access journal
Research Article Open Access
Hans and Yelland, J Clinic Res Bioeth 2013, S1
DOI: 10.4172/2155-9627.S1-008
*Corresponding author: Jason D Hans, Department of Family Sciences, 315
Funkhouser Building, University of Kentucky, Lexington, KY 40514, USA, E-mail:
jhans@uky.edu
Received February 15, 2013; Accepted May 13, 2013; Published June 07, 2013
Citation: Hans JD, Yelland EL (2013) American Attitudes in Context: Posthumous
Sperm Retrieval and Reproduction. J Clinic Res Bioeth S1: 008. doi:10.4172/2155-
9627.S1-008
Copyright: © 2013 Hans JD. This is an open-access article distributed under the
terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited.
American Attitudes in Context: Posthumous Sperm Retrieval and
Reproduction
Jason D Hans* and Erin L Yelland
Department of Family Sciences, University of Kentucky, USA
Abstract
Although still exceedingly uncommon, evidence suggests that the prevalence of posthumous sperm retrieval
requests for reproductive purposes has increased in recent years within the United States. These requests raise
complex issues that pose challenges for physicians, legal scholars, and bioethicists. This study is among the rst to
examine the general population’s attitudes toward posthumous sperm retrieval and, more generally, toward posthumous
reproduction. Specically, the effects of ve contextual circumstances—marital status, parental status, wishes of the
deceased’s parents, context of death, and the wishes of the deceased—on attitudes toward posthumous sperm retrieval
for the purpose of cryopreservation and reproduction were examined using a multiple segment factorial vignette with
a probability sample of 846 households in the United States. Marital status, disposition of the deceased’s parents, and
the deceased’s wishes affected attitudes in predictable directions, parental status and cause of death had little bearing
on attitudes, and respondent religiosity was negatively related to the perceived acceptability of posthumous sperm
retrieval as well as medical professional’s obligation to perform the procedure.
Keywords: Attitudes; Gamete cryopreservation; Posthumous
harvesting; Posthumous reproduction; Sperm retrieval
Introduction
Gamete cryopreservation is typically performed with the donor’s
knowledge and consent as insurance against an impending experience
that may lead to infertility, but retrieving (sometimes referred to
as harvesting) gametes from incapacitated or deceased individuals
without the donor’s consent also occurs. For example, cases have been
documented in which spouses, intimate partners, and parents have
requested that gametes be retrieved from patients in vegetative states,
comas, or who had been diagnosed as brain dead [1,2]. Requests may
also come from surviving partners or family members for postmortem
retrieval from a cadaver in the hours following an unexpected death,
especially when the deceased individual or couple’s reproductive plans
had not reached fruition prior to an untimely death [3].
Posthumous sperm retrieval for the purpose of procreation was rst
reported by Rothman in 1980 [4], and the rst successful pregnancy
using sperm retrieved from a cadaver occurred in 1998 followed by
the subsequent birth in 1999 [5]. Although retrieval, cryopreservation,
and subsequent conception are straight forward procedures when
the deceased is male, the procedures are medically and legally more
complex when the deceased is female (e.g., a surrogate mother is
needed) and a conception using gametes posthumously retrieved from
a female has not yet been reported.
Some countries have established laws banning or regulating
posthumous gamete retrieval and conception, but the practice is not
prohibited by law in most countries, including the United States.
Although permissible in most locations, the ethical and legal issues
associated with posthumous reproduction are among the “most
challenging, dicult and sensitive one is likely to encounter in any
eld of medicine” [6]. For example, one hospital ethics committee
tasked with providing advice to physicians about the ethics of
posthumously retrieving sperm in a particular case focused instead on
liability concerns, apparently unable to provide guidance on the ethics
of the procedure itself [2]. at said, some hospitals have developed
guidelines for postmortem sperm retrieval, such as those established
by Cornell University and utilized by several New York hospitals [7];
hereaer referred to as the Cornell guidelines].
e Cornell guidelines emphasize four areas of consideration:
(a) issues of consent, (b) medical contraindications, (c) resource
availability, and (d) a waiting period prior to conception. More
specically, the guidelines stipulate that consent of the deceased
must be presumed, consent for retrieval can only be provided by the
deceased’s wife, the death must have been sudden and for reasons not
due to a communicable disease or one known to aect sperm viability,
retrieval must take place within 24 hours of death, cryopreservation
must be available locally, the wife must wait a year prior to using the
sperm, and the sperm should be screened for communicable diseases. A
retrospective review of 22 cases where postmortem sperm retrieval was
requested between 1994 and 2002 found that 18 were not candidates
for retrieval based on the Cornell guidelines, and among the four cases
where retrieval was performed, only one wife had attempted pregnancy
using the cryopreserved sperm [8].
Although bioethicists and legal scholars have written extensively
about what should or should not be permitted or considered in the
context of posthumous gamete retrieval, only a few studies have
examined perceptions among the general population. One such study
focused on posthumous donation of female gametes to unknown
recipients and found that, among a representative sample of Utah
residents, 57% of respondents “were comfortable donating their own or
partner’s oocytes for fertilization and transfer of the resulting embryos
to a couple desiring pregnancy” in the event of death [9]. Another study
of couples presenting for their rst fertility consultation in New York
found that 85% of males and 72% of females “would permit their spouse
to harvest their [own] eggs/sperm for the purpose of conceiving a child
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ISSN: 2155-9627

Citation: Hans JD, Yelland EL (2013) American Attitudes in Context: Posthumous Sperm Retrieval and Reproduction. J Clinic Res Bioeth S1: 008.
doi:10.4172/2155-9627.S1-008
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J Clinic Res Bioeth Ethics: Reproductive Technologies ISSN: 2155-9627 JCRB, an open access journal
aer their death” [10]. An intercouple analysis of these respondents
found that 79% of females and 71% of males accurately predicted their
spouse’s response to this question. Another study based on a national
probability sample of 2,074 households in the continental United States
found that 64% of males and 55% of females were comfortable with the
prospect of their gametes being used posthumously by a partner if an
early death were to occur [11].
Using a probability sample of Kentucky households, Hans [3]
administered a more sophisticated true-experiment survey design using
a vignette. Specically, a hypothetical scenario was presented in which
posthumous gamete retrieval was requested by a surviving spouse or
partner. Several key details in the vignette—sex of the deceased, marital
status, relationship length, circumstances of the death, parental status
and plans of the couple, wishes of the deceased, and disposition of the
deceased’s parents—were independently and randomly manipulated
across respondents, allowing causal attributions to be made about
how contextual circumstances aected attitudes. Overall, the results
indicated that context matters when posthumous retrieval of gametes
is requested. For example, support for posthumous gamete retrieval
ranged from about 80% among those whose vignette presented a
married couple with written consent from the deceased, to less than
20% among those whose vignette presented a cohabiting couple who
had never discussed posthumous retrieval and the deceased’s parents
were unsupportive of the retrieval request. Also, respondents with
more education tended to be more supportive of posthumous gamete
retrieval, and respondents who more closely identied with their
chosen religion tended to be less supportive of the gamete retrieval
request.
e research design employed by Hans [3] uniquely documented
the eects of contextual circumstances on attitudes toward posthumous
gamete retrieval. However, the generalizability of those ndings is
limited because they were based on a probability sample of Kentucky
households. Given the strength of the true-experiment design for
examining attitudes juxtaposed with the sample limitations, the
purpose of this study is to examine whether Hans’ ndings replicate
with a larger national sample. Specically, we examine the eects of ve
contextual variables on attitudes toward posthumous sperm retrieval
for the purpose of procreation: (a) marital status, (b) parental status,
(c) wishes of the deceased’s parents, (d) context of death, and (e) the
deceased’s wishes. Prior to describing the design and vignette in greater
detail, we briey explain our rationale for examining each of these
variables.
Marital status
e Cornell guidelines stipulate that only a wife should be able
to give permission for posthumous sperm retrieval. Not surprisingly,
requests for retrieval are most commonly made by wives [12],
and Hans [3] found that attitudes toward both the procedure and
physicians’ obligation to assist were more favorable when requested by
a wife than by a cohabiting partner. However, several cases have arisen
where ancées and cohabiting girlfriends have wanted to reproduce
using the sperm of a deceased partner [12,13], and these requests are
likely to become more common as the marriage rate declines and age
at marriage continues to rise [14], and as cohabitation becomes more
common among reproductive-aged couples.
e prevalence of cohabitation among unmarried other-sex
partners in the United States increased 18% over a recent 4-year
period, from 6.4 million in 2007 to 7.6 million in 2011 [15]. As a
result, unmarried cohabiting couples now comprise over 11% of all
other-sex couples who live together, and 12.5% of all children under
1 year of age are living with both biological parents but their parents
are unmarried [16]. Moreover, the majority of these cohabiting
relationships will end in marriage. e National Survey of Family
Growth [17] found that, among cohabiting respondents, more than
one-third were engaged or had plans to marry at the time they began
cohabiting, and about two-thirds reported better than a 50-50 chance
of marriage with their cohabiting partner. Indeed, 60% of women’s
rst cohabitation experience ends as a result of transitioning into
marriage with her cohabitation partner [18]. ese numbers indicate
that many cohabiting couples have children together without or prior
to marriage, and an even larger portion of cohabiters will transition
into marriage and have children within marriage in due time. us,
although unmarried cohabiting partners generally do not have the
rights and responsibilities of spouses, it is not unreasonable to presume
that many cohabiting couples wish to, and eventually will, procreate
together.
Parental status
Some fertility treatment centers only assist with posthumous
reproduction to produce a sibling in cases where the couple already had
a child [19]. e motivation to produce a sibling for an only child may
be rooted in long-standing negative stereotypes about the personality
of only children, who have been labeled as spoiled and overindulged
for over a century [20,21]. However, research has found few dierences
between only children and those with siblings, and where dierences
do exist they oen favor only children [22]. Moreover, if the couple
has already produced ospring then it seems reasonable to argue that
the procreative desires [23] of the couple have been suciently satiated.
Conversely, unfullled procreative desires may provide a compelling
rationale in favor of posthumous reproduction for those who had not
yet produced a child.
Wishes of the deceased’s parents
e Revised Uniform Anatomical Gi Act [24] provides the legal
framework for determining who can request posthumous gamete
retrieval and donation [3]. e RUAGA stipulates that a spouse
has decision-making priority before a parent and that a parent has
decision-making authority before an unmarried cohabiting partner
of the deceased unless, according to Section 9 (a) (1), the parent or
intimate partner is acting as “an agent of the decedent at the time of
death.” us, in most cases a widow has sucient legal status under
the RUAGA to request posthumous sperm retrieval. Alternatively, if
the deceased was not married and his parents hold decision-making
authority then they have sucient legal status under the RUAGA to
block a retrieval request by an intimate partner.
In any case, however, physicians are not compelled to perform any
medical procedure except in cases of emergency [25], so those opposed
to the procedure for any reason may refuse a retrieval request even
if made by a spouse or parent with sucient legal status. A request
for posthumous sperm retrieval may or may not be dened as an
emergency; the request necessitates immediate attention because,
according to the Cornell guidelines, sperm are only fully viable for
about 3 hours postmortem then progressively degrade until they
become unviable roughly 24 hours postmortem, but the situation is
not life-threatening. us, posthumous sperm retrieval is a unique
situation in which the requested medical procedure must be performed
immediately to succeed but can justly be argued does not constitute a
bona de emergency.

Citation: Hans JD, Yelland EL (2013) American Attitudes in Context: Posthumous Sperm Retrieval and Reproduction. J Clinic Res Bioeth S1: 008.
doi:10.4172/2155-9627.S1-008
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J Clinic Res Bioeth Ethics: Reproductive Technologies ISSN: 2155-9627 JCRB, an open access journal
Given the latitude for physicians to exercise judgment in these
cases, one factor that may sway a physician experiencing ambivalence
concerning a widow’s request for posthumous sperm retrieval is
whether the wishes of the deceased’s parents are concordant with those
of the widow. In fact, the Cornell guidelines indicate that, although the
wife should be the one who makes a decision about postmortem sperm
retrieval, conict among interested parties is a contraindication to the
procedure.
Although cases have arisen where parents requested posthumous
sperm retrieval from a deceased unmarried child to provide the
possibility for a biological grandchild [26-28], cases have also occurred
where the deceased’s parents have not been supportive of a spouse’s
retrieval request. In one such case, the widow of a soldier obtained a
court ruling allowing the deceased’s sperm to be retrieved over the
objections of his mother, who had control of the remains [29]. Another
mother sought legal intervention to prevent conception using her
deceased son’s cryopreserved sperm, which he had stored prior to
beginning chemotherapy treatments and later donated to his girlfriend
[30]. In yet another family, a soldier had cryopreserved his sperm prior
to deployment so his wife could continue attempting to conceive in his
absence. Conception had not yet occurred when he died but was still
desired by his wife; the soldier’s parents were initially not supportive,
but later embraced the wife’s decision [31].
Context of death
e Cornell guidelines stipulate that sperm should only be
retrieved posthumously if the death occurred unexpectedly. Although
not stated, this requirement is presumably based on an assumption that
the deceased would have cryopreserved his sperm himself if death was
known to be imminent and he consented to posthumous conception.
e argument is logical, but Hans [3] did not nd any meaningful
dierences in attitudes toward posthumous gamete retrieval according
to whether a death was anticipated (cancer) or sudden (car accident).
In addition to whether the death could have been anticipated,
cause is another dimension of death that may aect attitudes toward
posthumous sperm retrieval. If one is culpable in his own death, as in
the case of suicide or other reckless behavior, then public sentiment
for the deceased and his desire to produce ospring may be muted.
Examples of cases where the deceased was to some degree culpable in
his own death include two mothers of unmarried young adult sons
who requested postmortem sperm retrieval following deaths attributed
to ghting [26] and Russian roulette [32]; technically, this wasn’t a
case of postmortem sperm retrieval because the young man was still
on life support when the sperm was retrieved). In the latter case the
mother indicated that she was doing what her son wanted, and in the
former case the mother indicated that this was her only chance to have
a grandchild, suggesting both altruistic and egocentric motivations for
posthumous reproduction.
In contrast to cases where the deceased is responsible in his own
death, a great deal of latitude may be aorded to those who die in heroic
fashion, such as a police ocer who dies in the line of duty. Doucettperry
[33], a U.S. Army judge, has argued that posthumous reproduction
among service members should be limited to those who cryopreserve
their sperm prior to death and some American and British soldiers
cryopreserved their sperm as an insurance policy against infertility or
death prior to deploying to Afghanistan or Iraq [34-38]. Moreover, at
least one cryopreservation company oered a discount for members of
the military who were deploying [39]. However, most soldiers do not
cryopreserve their sperm prior to deployment, and cases have arisen
where widows of soldiers have requested postmortem sperm retrieval
to preserve the possibility of producing genetic ospring with their
deceased husbands aer some time has passed following the death [29].
Focusing on the context of death, whether the deceased was
heroic or culpable, seems to presume that posthumous reproduction
memorializes the deceased by creating what a French court termed a
baby souvenir [40-42]. ere is no doubt some degree of memorializing
associated with posthumous reproduction, similar to the sense of
legacy that having a child provides living parents. However, a strong
argument could be made that posthumous reproduction has a more
profound eect on the deceased’s survivors and the resulting ospring
than it does on the deceased’s legacy.
Wishes of deceased
e deceased’s wishes are the strongest predictor of attitudes
toward posthumous gamete retrieval and beliefs concerning the degree
of obligation medical professionals have to assist with a request for
postmortem gamete retrieval [3]. e caveat is that the deceased’s
wishes are oen unknown and cannot be directly obtained; interested
parties are le to speculate about what the deceased may have wanted.
Procreation is viewed as a fundamental legal right by the U.S.
Supreme Court [43,44], although the application of that right to
posthumous reproduction is unclear [45]. e United Kingdom’s
Human Fertilization and Embryology Act of1990 requires express
written consent from the deceased for posthumous sperm retrieval
[46]. Bennett [47] and Schi [48] took that position by contending
that even dying in the act of attempting to conceive is not sucient
evidence to infer the deceased’s wishes to conceive posthumously
because posthumous parenthood does not provide the experiences
that make parenthood meaningful while living [49]. e stringency of
a written consent standard, however, would preclude nearly all cases
of postmortem sperm retrieval, particularly in cases of unexpected
death, because adults of reproductive age rarely plan for death [50,51].
Consequently, others [52] have argued that the procedure could also
be appropriate when there is compelling evidence to suggest that the
deceased would have consented, if given the opportunity.
e Cornell guidelines take this more tolerant position by providing
that a man’s behaviors and statements prior to death indicating a clear
intent to have ospring should be sucient to warrant a widow’s
request for postmortem sperm retrieval. Others have gone further by
suggesting that childbirth is so common in marriage that marriage
itself can be construed as intent to procreate [53], and the United States
has generally taken a laissez-faire approach to regulating postmortem
gamete retrieval. e Ethics Committee for the American Society for
Reproductive Medicine [54] recommends but does not require explicit
consent of the deceased and states that there is no ethical duty to honor
a retrieval request but that context and professional judgment should
be used on a case by case basis.
Although there is little debate in the United States concerning
the acceptability of posthumous gamete retrieval and conception,
particularly when the deceased provided clear instructions, legislation
has been developed to place practical limitations on claims against the
deceased’s estate. For example, the Uniform Parentage Act [55] limits
paternity to ospring born within 300 days of a father’s death, unless
the deceased otherwise consented in writing. e Uniform Probate
Code [56] was amended in 2008 to address posthumously conceived
children and treats a child as living at the time of a parent’s death
for probate purposes if (a) the deceased consented to posthumous

Citation: Hans JD, Yelland EL (2013) American Attitudes in Context: Posthumous Sperm Retrieval and Reproduction. J Clinic Res Bioeth S1: 008.
doi:10.4172/2155-9627.S1-008
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J Clinic Res Bioeth Ethics: Reproductive Technologies ISSN: 2155-9627 JCRB, an open access journal
conception in writing, (b) the child is in utero within 36 months or is
born within 45 months of the deceased’s death, and (c) the child lives
120 hours aer birth. us, although the absence of explicit consent
does not preclude postmortem sperm retrieval in the United States,
having explicit consent does aord legal status to resulting ospring.
Method
Sample
Respondents were contacted using a modied, list-assisted
Waksberg [57] random-digit dialing method giving every household
telephone in the continental United States an equal probability of being
contacted. To reduce within-unit sampling bias, the respondent within
each household was randomly selected according to the youngest
or oldest adult of a given sex living in the household. Up to 15 call
attempts were made to each telephone number in the sample, and a
conversion attempt was made for each initial refusal.
ese procedures resulted in a sample of 846 respondents, ranging
in age from 18 to 95 years (M=50, SD=16). e majority of respondents
were female (62%), married (63%), White (82%), and had children
(76%). Level of formal education was diverse: 20% had a post-bachelor’s
degree, 24% had a bachelor’s degree, 33% had completed some college
but did not have a degree, 19% had a high school diploma, and 5%
had less than a high school diploma. Roughly 11% reported ever being
widowed. Relative to the U.S. population from which this sample was
drawn, Whites, females, college educated, and married individuals were
overrepresented [58,59]. e distribution of religious aliation was
generally consistent with the U.S. population as reported by the Pew
Forum on Religion and Public Life [60]; the most commonly reported
religious aliations were Protestant (54%) and Catholic (27%). Overall,
38% indicated that they were very religious, 35% classied themselves
as somewhat religious, 13% were slightly religious, and 15% were not
religious.
Design and procedure
Multiple Segment Factorial Vignettes (MSFVs) combine the
random manipulation of variables in factorial designs and the
contextual richness of multiple segment vignettes [61]. e three-
segment vignette designed for this study described a ctional situation
where a surviving wife or cohabiting girlfriend wished to have the
sperm of her deceased partner posthumously retrieved to conceive
a child. Respondents were randomly presented one of 48 versions of
the vignette, which varied by manipulation of ve independent design
variables that were embedded within the vignette: (a) marital status,
(b) parental status, (c) wishes of the deceased’s parents, (d) context of
death, and (e) wishes of the deceased.
In the rst segment, respondents were told about a couple who had
either been cohabitating or married for several years and who either
did or did not already have a child when the husband suddenly died.
Following his death, the wife requested that her partner’s sperm be
retrieved and cryopreserved so she could potentially have a/another
child with him. As an example, the version that portrayed the couple
as married and not having a child together was presented as follows
(independent variables are italicized):
Robert and Angela have been happily married for several years.
ey did not have a child together but were planning to eventually
have a child when Robert suddenly died. Following his death, Angela
asked doctors to freeze Robert’s sperm so she could potentially have a
biological child with Robert aer some time has passed following his
death (Segment 1 example).
Respondents were then asked: (a) “Do you think Angela should
or should not be able to have her deceased husband/partner’s sperm
frozen?” and (b) “For this procedure to be successful, the sperm
would have to be frozen within 24 hours of Robert’s death. Given the
time-sensitive nature of this procedure, how obligated are medical
professionals to follow Angela’s wishes; would you say highly obligated,
moderately obligated, slightly obligated, or not at all obligated?” en,
respondents were instructed, “Briey explain in your own words why
you chose these answers,” and their responses were typed verbatim.
In the next vignette segment, which continued the hypothetical
story from the rst segment, the deceased partner’s parents were
depicted as being either supportive or unsupportive of the request to
cryopreserve their son’s sperm. In the following example, the deceased’s
parents were unsupportive of the decision:
During a family consultation to discuss the requested procedure,
the medical professional learns that Robert’s parents are unsupportive
of Angela’s desire to freeze his sperm (Segment 2 example).
Aer hearing the second segment, respondents were asked: (a)
“Given this new information, do you think Angela should or should
not be able to have her deceased husband/partner’s sperm frozen?” and
(b) “Keeping in mind the time-sensitive nature of this procedure, how
obligated are medical professionals to follow Angela’s wishes; would
you say highly obligated, moderately obligated, somewhat obligated,
or not at all obligated?” Once again, respondents were also asked to
provide a rationale for their answers.
e third segment of the vignette revealed the nal two independent
variables: context of death and wishes of the deceased. e context of
death was depicted as either a soldier who had died in combat or a thrill
seeker who had died in a bungee-jumping accident. Respondents were
also told that the couple had previously discussed the risks involved
with either military deployment or thrill-seeking adventures and that
the deceased had agreed in writing, agreed orally, or had not discussed
the possibility of posthumous reproduction if he were to experience
an untimely death. e following example depicts Robert as a soldier
and indicates that he and Angela had not discussed the possibility of
posthumous reproduction in the event of his death:
It turns out that Robert was a soldier and died in combat. e
couple had discussed the risks involved in Robert’s deployment, but
they had not discussed the possibility of having his sperm frozen to have
a child aer his death if something were to happen to him (Segment 3
example).
e same two questions that were asked following the second
segment were then repeated, followed by the request to provide a
rationale for those responses.
Analytic approach
Logistic regression models were created for each of the three
questions that asked whether postmortem sperm retrieval should or
should not be allowed, and ordinal regression models were created for
each of the three questions about medical professionals’ obligation to
assist. In all six regression models, the main eects of the independent
design variables were forced into the models, then a planned interaction
(i.e., marital status x parents’ wishes) was entered using a stepwise
procedure, and in the nal entry block respondent characteristics were
forced into the models.
e rationales respondents provided for their responses to the
closed-ended questions were typed verbatim and coded inductively.

Citation: Hans JD, Yelland EL (2013) American Attitudes in Context: Posthumous Sperm Retrieval and Reproduction. J Clinic Res Bioeth S1: 008.
doi:10.4172/2155-9627.S1-008
Page 5 of 9
J Clinic Res Bioeth Ethics: Reproductive Technologies ISSN: 2155-9627 JCRB, an open access journal
e coding unit was a unique rationale, so a single response may have
been coded into multiple categories. Approximately one-third of the
responses were coded by a second coder to test for inter-rater reliability,
which resulted in a substantial amount of agreement (kappa=0.76)
between the two coders [62].
Results
Should posthumous gamete retrieval be allowed?
Overall, the majority of respondents indicated that the request for
posthumous sperm retrieval should be allowed regardless of which
versions of the independent variables they were presented (Table
1). However, responses were consistently aected across vignette
segments by several independent variables and respondent religiosity.
Specically, respondents who heard about a cohabiting couple and
those who heard that the deceased’s parents were unsupportive
were about half as likely to say that the procedure should be allowed
compared to those who heard about a married couple and those who
heard about supportive parents, respectively. e strongest predictor of
responses, however, was the deceased’s wishes; respondents were over
2.5 times more likely to indicate that the sperm should be retrieved if
they heard that the deceased had concurred with the procedure, either
orally or in writing, prior to death than if they heard that the couple had
not discussed the possibility of posthumous reproduction. Religiosity
was the only respondent characteristic that was statistically related
to the responses; the more closely respondents identied with their
religious aliation the less likely they were to indicate that posthumous
sperm retrieval should be allowed. Complete statistical results for the
logistic regression analyses are presented in Table 2.
How obligated are medical professionals?
Responses to the items asking how obligated medical professionals
were to assist with the posthumous sperm retrieval request were
distributed consistently across vignette segments; among those who had
an opinion, roughly 40% of respondents selected highly obligated, 20%
said moderately obligated, 10% chose slightly obligated, and 30% said
not at all obligated. However, the descriptive statistics depicted in Table
3 suggest that responses varied according to some of the independent
variables. Specically, responses varied in consistent and predictable
ways according to the marital status, wishes of the deceased’s parents,
and deceased’s wishes depicted in the vignette, and respondents who
more closely identied with their religious aliation tended to intuit
less obligation to assist on the part of medical professionals. Beliefs
about the degree of obligation on the part of medical professionals to
assist with the requested procedure did not statistically vary according
to the parental status or context of death depicted in the vignette. Also,
although these respondents attributed more obligation if they heard
that the deceased’s wishes had been in writing than if they heard that
the wishes had been stated verbally, the size of that dierence was
too small to make a statistical distinction with these data. Complete
statistical results for the ordinal regression analyses are presented in
Table 4.
Rationale for responses
e most frequent rationales provided for responses to the closed-
ended questions are summarized in Table 5. e results substantiate
the quantitative results in that many respondents referenced the
couple’s marital status, the opinion of the deceased’s parents, and the
deceased’s wishes when explaining their responses. Moreover, only one
respondent referenced parental status by suggesting that the procedure
should be allowed to provide a sibling for an existing child, and no
rationales were provided referencing the context of death that had been
portrayed in the vignette.
Although the relative frequency of rationales that referenced
the independent variables were generally in the expected directions
according to the statistical results described above, responses were
more nuanced with regard to the opinion of the deceased’s parents.
Respondents who stated that posthumous sperm retrieval should not
be allowed rarely cited the lack of parental support as justication for
that position, regardless of whether the couple was depicted as married
or cohabiting. ese respondents seemed to view unsupportive parents
as merely substantiating an already entrenched position. Perhaps for
similar reasons, respondents who remained opposed to the requested
procedure aer hearing that the deceased’s parents were supportive
oen dismissed the parents’ position as unimportant, and those who
heard about a cohabiting couple (24%) were more likely to do so than
those who heard about a married couple (12%).
Compared to those who were opposed to retrieval of the sperm,
respondents in favor of retrieval were much more likely to cite
the parents’ position in their rationales. ose who heard about
supportive parents frequently stated that the parents’ opinion is
important regardless of whether they heard about a cohabiting (37%)
or a married (50%) couple, and those who heard about unsupportive
parents frequently stated that the parents’ opinion was unimportant
regardless of whether they heard about a cohabiting (33%) or married
(24%) couple. In short, these response patterns indicate that many
respondents downplayed the parents’ opinion if it was discordant
with their own pre-existing or otherwise-determined position, or the
parents’ opinion tended to be absent from the rationale in cases where
both the respondent and the parents were opposed to retrieval.
In addition to the independent variables, many who believed
posthumous sperm retrieval should be allowed indicated that it was the
surviving partner’s decision to make, and others intuited that there was
an agreement between the couple in the rst and second segments even
before any history of a discussion between the couple was revealed in the
third segment. ose who indicated that posthumous retrieval should
not be allowed were more varied in the rationales they provided; many
believed the surviving partner should move on with her life rather than
try to have a child with the deceased partner, concern was expressed for
Table 1: Percentage of Responses within Each Level of the Independent Variables.
Should or should not be allowed?
Independent variable nShould not Should Don’t know
Marital status
Cohabitating 434 43.5 51.4 5.1
Married 407 29.7 66.8 3.4
Parental status
No children 415 36.4 59.8 3.9
Had children 426 37.3 58.0 4.7
Wishes of deceased’s parents
Not in favor 409 42.3 51.1 6.6
Supportive 430 25.8 71.2 3.0
Cause of death
Soldier 414 27.5 68.8 3.6
Thrill seeker 426 30.0 66.2 3.8
Wishes of deceased
Unknown 302 39.7 55.0 5.3
Verbal 270 23.3 74.4 2.2
Written 268 22.0 74.6 3.4

Citation: Hans JD, Yelland EL (2013) American Attitudes in Context: Posthumous Sperm Retrieval and Reproduction. J Clinic Res Bioeth S1: 008.
doi:10.4172/2155-9627.S1-008
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J Clinic Res Bioeth Ethics: Reproductive Technologies ISSN: 2155-9627 JCRB, an open access journal
the child who would be born without a father into a single-parent home,
and others objected based on a belief that posthumous gamete retrieval
and reproduction is in some way unethical, immoral, unnatural, or is a
form of “playing God.”
Note: Reference category in parentheses. CI = condence interval for odds ratio (OR)
Table 2: Logistic Regression Predicting Whether Retrieval of Deceased Husband’s Gametes Should be Allowed.
Segment 1
n = 745, should = 62%
Segment 2
n = 723, should = 65%
Segment 3
n = 725, should = 70%
Predictor B SE p OR 95% CI B SE p OR 95% CI B SE p OR 95% CI
Unmarried (married) - 0.67 .16 < .001 0.51 [0.38,
0.70]
- 0.74 .17 < .001 0.48 [0.35, 0.66] - 0.96 .18 < .001 0.38 [0.27, 0.54]
No children (had children) 0.06 .16 .725 1.06 [0.78,
1.44]
0.00 .17 .987 1.00 [0.73, 1.39] - 0.09 .18 .614 0.92 [0.65, 1.29]
Parents’ unsupportive (supportive) - 0.85 .17 < .001 0.43 [0.31, 0.59] - 0.50 .18 .004 0.61 [0.43, 0.85]
Soldier died in combat (died bungee-jumping) 0.04 .18 .822 1.04 [0.74, 1.47]
Deceased’s wishes unknown (verbal
consent)
- 0.89 .21 < .001 0.41 [0.27, 0.63]
Deceased’s wishes unknown (written
consent)
- 0.86 .21 < .001 0.42 [0.28, 0.64]
Deceased consented verbally (written
consent)
- 0.03 .23 .901 0.97 [0.62, 1.53]
Respondent characteristics
Age - 0.00 .01 .784 1.00 [0.99,
1.01]
0.00 .01 .979 1.00 [0.99, 1.01] - 0.00 .01 .879 1.00 [0.99, 1.01]
Education - 0.10 .07 .162 0.91 [0.79,
1.04]
- 0.07 .07 .339 0.93 [0.81, 1.08] 0.01 .08 .893 1.01 [0.87, 1.18]
Income - 0.14 .07 .037 0.87 [0.77,
0.99]
- 0.10 .07 .168 0.91 [0.80, 1.04] - 0.02 .07 .836 0.99 [0.86, 1.13]
Male (female) 0.15 .17 .353 1.17 [0.84,
1.61]
- 0.11 .17 .518 0.90 [0.64, 1.25] - 0.14 .18 .457 0.87 [0.61, 1.25]
Never been married (has been married) - 0.02 .31 .938 0.98 [0.54,
1.78]
0.10 .32 .748 1.11 [0.59, 2.08] 0.01 .35 .983 1.01 [0.51, 2.00]
Never been widowed (has been widowed) - 0.37 .28 .179 0.69 [0.40,
1.18]
- 0.26 .29 .374 0.77 [0.44, 1.36] 0.23 .29 .426 1.26 [0.71, 2.24]
Never had children (has had children) 0.35 .24 .146 1.42 [0.89,
2.28]
0.51 .26 .047 1.66 [1.01, 2.75] 0.50 .28 .075 1.64 [0.95, 2.84]
Religiosity - 0.23 .09 .007 0.79 [0.67,
0.94]
- 0.23 .09 .012 0.79 [0.66, 0.95] - 0.38 .10 < .001 0.69 [0.56, 0.84]
Religion
Catholic (no preference) - 0.40 .49 .413 0.67 [0.26,
1.74]
0.27 .46 .563 1.31 [0.53, 3.24] 0.45 .50 .368 1.57 [0.59, 4.15]
Jewish (no preference) 0.34 .76 .655 1.40 [0.32,
6.16]
0.95 .82 .247 2.58 [0.52,
12.77]
0.07 .75 .927 1.07 [0.25, 4.68]
Protestant (no preference) - 0.49 .48 .305 0.61 [0.24,
1.56]
0.13 .45 .770 1.14 [0.47, 2.76] 0.32 .49 .510 1.38 [0.53, 3.56]
How obligated are medical professionals to assist?
Independent variable nNot at all Slightly Moderately Highly Don’t know
Marital status
Cohabitating 434 39.4 9.2 18.9 28.3 4.1
Married 406 22.2 11.3 20.2 42.4 3.9
Parental status
No children 414 31.9 10.1 18.8 34.5 4.6
Had children 426 30.3 10.3 20.2 35.7 3.5
Wishes of deceased’s parents
Not in favor 408 33.8 15.2 16.7 30.4 3.9
Supportive 430 24.2 9.1 19.8 45.6 1.4
Cause of death
Soldier 414 25.8 9.4 19.6 42.5 2.7
Thrill seeker 426 26.1 9.6 17.4 44.1 2.8
Wishes of deceased
Unknown 302 32.5 10.6 20.5 33.4 3.0
Verbal 271 21.8 10.3 19.2 45.4 3.3
Written 267 22.8 7.5 15.4 52.4 1.9
Table 3: Percentage of Responses within Each Level of the Independent Variables.

Citation: Hans JD, Yelland EL (2013) American Attitudes in Context: Posthumous Sperm Retrieval and Reproduction. J Clinic Res Bioeth S1: 008.
doi:10.4172/2155-9627.S1-008
Page 7 of 9
J Clinic Res Bioeth Ethics: Reproductive Technologies ISSN: 2155-9627 JCRB, an open access journal
Note: Reference category in parentheses. CI = condence interval for odds ratio (OR)
Table 4: Ordinal Regression Predicting How Obligated Medical Professionals are to Follow Widow’s Wishes to Retrieve Deceased Husband’s Gametes.
Segment 1
n = 722
Segment 2
n = 729
Segment 3
n = 727
Predictor B SE p OR 95% CI B SE p OR 95% CI B SE P OR 95% CI
Unmarried (married) - 0.77 .14 < .001 0.46 [0.35, 0.61] - 0.70 .14 < .001 0.49 [0.38,
0.65]
- 0.69 .14 < .001 0.50 [0.38, 0.66]
No children (had children) - 0.12 .14 .385 0.89 [0.67, 1.16] - 0.01 .14 .917 0.99 [0.75,
1.29]
- 0.06 .14 .682 0.94 [0.71, 1.25]
Parents’ unsupportive (supportive) - 0.68 .14 < .001 0.51 [0.38,
0.67]
- 0.35 .14 .013 0.70 [0.53, 0.93]
Soldier died in combat (died bungee-
jumping)
-0.04 .14 .767 0.96 [0.73, 1.26]
Deceased’s wishes unknown (verbal
consent)
- 0.52 .17 .002 0.60 [0.43, 0.83]
Deceased’s wishes unknown (written
consent)
- 0.65 .17 < .001 0.52 [0.37, 0.74]
Deceased consented verbally
(written consent)
- 0.13 .18 .476 0.88 [0.62, 1.25]
Respondent characteristics
Age - 0.01 .01 .195 0.99 [0.98, 1.00] 0.00 .01 .353 1.00 [0.98,
1.01]
- 0.01 .01 .081 0.99 [0.98, 1.00]
Education - 0.14 .06 .028 0.87 [0.77, 0.99] - 0.11 .06 .070 0.89 [0.79,
1.01]
- 0.06 .06 .332 0.94 [0.83,1.07]
Income - 0.07 .06 .257 0.94 [0.84, 1.05] - 0.05 .06 .397 0.95 [0.85,
1.07]
- 0.01 .06 .892 0.99 [0.88, 1.11]
Male (female) - 0.04 .15 .775 0.96 [0.72, 1.28] - 0.07 .15 .649 0.94 [0.70,
1.24]
- 0.04 .15 .777 0.96 [0.72, 1.28]
Never been married (has been married) - 0.07 .26 .796 0.93 [0.56, 1.57] - 0.03 .26 .924 0.98 [0.58,
1.63]
- 0.07 .27 .806 0.94 [0.55, 1.59]
Never been widowed (has been widowed) - 0.17 .24 .476 0.84 [0.53, 1.34] - 0.10 .24 .687 0.91 [0.57,
1.45]
- 0.13 .24 .596 0.88 [0.55, 1.41]
Never had children (has had children) 0.16 .21 .454 1.17 [0.78,1.76] 0.09 .21 .653 1.10 [0.73,
1.66]
0.20 .21 .358 1.22 [0.80, 1.85]
Religiosity - 0.17 .08 .025 0.84 [0.73, 0.98] - 0.14 .08 .075 0.87 [0.75,
1.01]
- 0.15 .08 .054 0.86 [0.74, 1.00]
Religion
Catholic (no preference) 0.49 .39 .212 1.63 [0.76, 3.49] - 0.36 .40 .364 0.32 [0.32,
1.52]
- 0.38 .41 .351 0.68 [0.30, 1.53]
Jewish (no preference) 1.22 .65 .060 3.38 [0.95, 12.08] 0.03 .67 .969 0.28 [0.28,
3.82]
- 0.50 .65 .437 0.60 [0.17, 2.15]
Protestant (no preference) 0.31 .38 .411 1.37 [0.65, 2.89] - 0.52 .39 .180 0.28 [0.28,
1.27]
- 0.50 .40 .217 0.61 [0.28, 1.34]
Segment 1 Segment 2 Segment 3
Rationale n%n%n%
Should 485 496 546
Survivor’s wishes or rights 125 25.8 111 22.4 106 19.4
Couple agreement 72 14.8 41 8.3 117 21.4
Married couple 51 10.5 58 11.7 23 4.2
Parents’ opinion irrelevant 103 20.8 18 3.3
Parents’ opinion important 89 17.9 35 6.4
Had documentation 65 11.9
Deceased’s wishes 56 10.3
Should not 302 270 235
Not married 74 27.4 65 24.1 45 19.1
Deceased’s wishes unknown 67 24.8 38 14.1 52 22.1
Move on with life 39 14.4 23 8.5 28 11.9
Concerns for child 35 13.0 30 11.1 32 13.6
Unnatural or religion 29 10.7 19 7.0 23 9.8
Lacking documentation 23 8.5 15 5.6 18 7.7
Ethical or moral concern 20 7.4 17 6.3 17 7.2
Parents’ opinion important 33 12.2 12 5.1
Parents’ opinion irrelevant 18 6.7 0 0.0
Table 5: Most common Rationale for whether Posthumous Conception Should or Should Not be Allowed.

Citation: Hans JD, Yelland EL (2013) American Attitudes in Context: Posthumous Sperm Retrieval and Reproduction. J Clinic Res Bioeth S1: 008.
doi:10.4172/2155-9627.S1-008
Page 8 of 9
J Clinic Res Bioeth Ethics: Reproductive Technologies ISSN: 2155-9627 JCRB, an open access journal
Discussion
e purpose of this study was to examine the eects of contextual
circumstances on attitudes toward posthumous retrieval of sperm for
the purpose of cryopreservation and subsequent reproduction. Results
consistently indicated that marital status, disposition of the deceased’s
parents, and the deceased’s wishes aected attitudes in the expected
directions, that parental status and cause of death had little bearing
on attitudes, and that respondent religiosity was negatively correlated
with the perceived acceptability of posthumous sperm retrieval. In
addition, the perceived obligation of medical professionals to assist
with a posthumous sperm retrieval request was closely aligned with the
perceived acceptability of the procedure itself.
Despite subtle vignette dierences, the directions and magnitudes
of these ndings are generally consistent with those obtained by Hans
[3] using a probability sample of Kentucky residents. However, there
were three notable dierences in our results: (a) odds ratios associated
with the deceased’s wishes were notably smaller, (b) the deceased’s
verbal consent to the procedure carried more weight relative to
written consent; the two were indistinguishable in our sample, and
(c) respondent education was not associated with attitudes toward the
procedure. ese dierences notwithstanding, the largely consistent
ndings between the two studies provide an added degree of condence
in our ndings.
ese ndings, buttressed by their consistency with those of
Hans [3], may be taken as tentative estimates of public opinion on
posthumous reproduction and could therefore rightfully inuence
policy and medical decision-making. However, attempts to apply these
ndings should be tempered by a few key limitations of these data.
Posthumous sperm retrieval and posthumous conception are
increasing in prevalence yet remain suciently rare to assume that the
vast majority of the population has never encountered these situations
within their social networks. e complexities of the issues inherent
in posthumous reproduction challenge bioethics panels who carefully
consider the various interests at stake, yet we asked respondents to make
on-the-spot decisions on issues for which they did not hold informed
or thoughtful positions. First-impression responses have some merit in
the sense that the positions taken are not directly inuenced by politics
and media pundits, and the sentiments expressed in these data may
therefore reect core values, but some people may arrive at dierent
or more nuanced positions with further and fuller consideration of
the issues at hand and interests at stake with regard to posthumous
reproduction.
Also, we asked what the characters in the vignettes should do, not
what our respondents would do, in the given situation. Although the
theory of planned behavior [63] suggests that attitudes and behaviors
are related to one another, we caution against assuming that responses
to these hypothetical vignette situations reect the decisions individuals
would make, or the wishes they would hold for themselves, if faced
with the same situation in their own lives. Emotional distance and the
absence of real-world consequences and context allow respondents
to make judgments in response to vignettes that may only vaguely
resemble the decision-making process one makes when fully immersed
in a real-world context. For example, Carlson [64] found a disconnect
between what respondents stated should happen in response to
vignettes depicting violent and abusive incidents in relationships and
what people who experience violence and abuse in their relationships
actually do. Similarly, relative to actual reported behavior, the results of
a vignette study on needle sharing among drug injectors demonstrated
a willingness to “irt with risky behavior at no personal cost” in
response to vignette scenarios [65].
With these limitations in mind, the multiple segment factorial
vignette design employed in this study is nonetheless appropriate
for understanding how various contextual circumstances aect
attitudes relative to one another. Our ndings provide evidence that
can appropriately be weighed in the decision-making process when
a posthumous retrieval request is made and, more generally, when
policies are formed that delineate acceptable contextual circumstances
for this procedure.
Conclusion
Medical advances enhance and extend life while simultaneously
challenging existing notions about the meaning and boundaries
of life, and few issues do so as provocatively as posthumous sperm
retrieval and reproduction. e numerous quagmires introduced by
posthumous reproduction thus far have been primarily examined
with philosophical arguments and legalistic commentary. is study
expands that conversation by providing the rst national survey data
in the United States focused on examining the perceived acceptability
of posthumous sperm retrieval in various contexts among the general
population. Overall, the ndings indicate that most Americans are
supportive of posthumous sperm retrieval and cryopreservation for
reproductive purposes, particularly when circumstances are deemed
favorable. Future research should build upon these ndings by
examining more varied contexts than was possible with the one vignette
we employed. In addition, the scope of investigation should expand to
take advantage of the fertile opportunities posthumous reproduction
presents for exploring the meaning and role of reproduction, ospring,
and parenting in modern life.
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This article was originally published in a special issue, Ethics: Reproductive
Technologies handled by Editor(s). Dr. Stephen Napier, Villanova University,
USA