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Topic: Assisted Reproduction
October 23, 2014 | Posted By Lisa Campo-Engelstein, PhD

A few weeks ago, I attended the annual Oncofertility Consortium conference where Dr. Angel Petropanagos and I presented our poster “Teen Boys and Fertility Preservation: An Ethical Analysis.”  The vast majority of discussions about fertility preservation (FP), particularly FP for “social” (aka nonmedical) reasons, are focused on women in part because FP for women raises more ethical issues.  For instance, egg freezing carries more health risks and is generally less effective than sperm freezing. Furthermore, whereas sperm freezing has been an established method of FP for decades, it was only two years ago that the American Society for Reproductive Medicine lifted the experimental label from egg freezing.

Yet, even established technologies can raise ethical concerns when used in vulnerable groups, such as children. Our research project examines the ethical issues FP raises when used by teenage boys.  In order to undergo sperm freezing, males must produce a sperm sample and this is usually done through masturbation. However, discussions about masturbation can be embarrassing and difficult for adolescent males (as well as for healthcare providers), particularly if they have never masturbated or never masturbated and achieved an ejaculation. Some parents and healthcare providers place a high value on preserving patients’ future option of genetic reproduction, but FP discussions with teen males can be especially challenging due to the sensitive and private nature of sexuality and reproduction. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

December 20, 2013 | Posted By Lisa Campo-Engelstein, PhD

There are many celebrities who make the news because they have used a gestational surrogate to have their children, including Sarah Jessica Parker, Guiliana Rancic, Elizabeth Banks, Nicole Kidman, Ricki Martin, Neil Patrick Harris, and Elton John. From the little information provided about their surrogacy arrangements, it seems like most of the celebrities partner with surrogates who live in the US. What is almost never mentioned in these articles is the legality and enforceability of surrogacy contracts, which can vary dramatically from state to state. Each state has to determine how they want to regulate surrogacy because there is no federal legislation, though there was a push for it following the infamous Baby M case. 

Surrogacy laws can be categorized into three categories. The first category is comprised of laws that permit surrogacy contracts by outlining the criteria for the contracts to be lawful and enforceable. For example, surrogacy laws in Florida require that the intended couple must be over 18 years old and married, the intended mother must be incapable of gestating a pregnancy without physical risk to herself or the fetus, and at least one of the intended parents must be biologically related to any resulting child. These requirements have to be fulfilled in order for any surrogacy contract to be legal and enforceable.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

September 17, 2013 | Posted By Lisa Campo-Engelstein, PhD

Testicular tissue cryopreservation is a neglected topic in the fields of fertility preservation and bioethics not only because reproduction is usually associated with women and girls, but also because sperm banking is an established, easy, and cheap method that works for the majority of male cancer patients. However, norms surrounding fatherhood are changing, with more men interested in active fatherhood, and consequently fertility preservation is becoming and will continue to become increasingly important to male cancer patients.

When compared to the number of studies demonstrating the importance of fertility to female cancer patients, the literature focusing on male cancer patients’ perspectives on fertility is minimal. However, there are more researchers examining the latter topic today than in the past. Contemporary research on gendered perspectives on fertility preservation reveals a shift over time: although older studies generally found that female cancer patients value their fertility

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

August 23, 2013 | Posted By Lisa Campo-Engelstein, PhD

Unlike organs, the U.S. allows gametes to be purchased. Given this dichotomy between the legal treatment of gametes and the legal treatment of organs, the question then arises: how should we legally classify ovaries, which can be used to treat both reproductive conditions (infertility) and non-reproductive conditions (premature menopause)?  

I believe ovarian tissue should be aligned with gametes rather than organs. I recognize that this leads to concerns about the sale of ovarian tissue (e.g., price, access, limitations, etc.). However, ovarian tissue like gametes and unlike other types of transplant, can lead to pregnancy, a socially and ethically important difference. The potential to create a new life is significant because new life often engenders new relationships and legal responsibilities. Whereas organ donors, both living and cadaveric, can remain anonymous, gamete donors typically cannot, at least not fully anonymous. Gamete donors are generally required to provide personal information on a variety of topics, such as physical characteristics, family medical history, religion, personal achievements, and personality traits. Potential recipients (and fertility centers) are usually the only ones who have access to this personal information. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

June 17, 2013 | Posted By Lisa Campo-Engelstein, PhD

One of the major concerns with human egg donation is that there is no federal or systematic oversight. The UK has the Human Fertilisation and Embryology Authority (HFEA) that regulates the use of gametes and embryos for fertility treatment and research. In contrast, the US is the “Wild West” when it comes to reproductive medicine as we lack any real regulation in this field (there are soft policy guidelines from various medical and scientific organizations but these don’t have teeth). 

Without any oversight, many concerns are raised about the screening of donors. For example, women can donate at multiple centers without any of the other centers knowing. There are no good studies on the effects of donating eggs numerous times, but many believe it could be detrimental to women’s health. Another problem with women donating to multiple centers is that if their eggs are to be used for research purposes, it could lead to less diversity in the research sample. If their eggs are being used for reproductive purposes, then there is a greater chance of creating many half-siblings. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

May 15, 2013 | Posted By Tara Bernardino

Mary Shanley argues against anonymous gamete donation on the basis of what she describes as the right of children conceived using donated gametes to “learn the identity of one’s genetic forebear.” Shanley believes this right stems from “some people’s desire to connect themselves to human history concretely as embodied beings…” I challenge Shanley’s viewpoint as being “progeny-centric,” because while it acknowledges the potential desire of the children created from gametes to learn information about the gamete donor, it fails to consider the rights or interests of that donor, both at the time of the donation, and later, when a child exists.  While I agree with Shanley that some children of gamete donors may desire identifying information about the donor, I disagree that those children have a right to access information about the donor beyond that which the donor agreed to provide or which was required at the time of donation such as genetic and medical history.  Instead I would propose a system where anonymity is optional, akin to the policy of open and closed adoption.  This approach recognizes the interests of the donor, respecting their right to privacy and medical confidentiality, while leaving open the possibility for any future children to inquire about their genetic origins and donor information.  

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

April 8, 2013 | Posted By Jane Jankowski, LMSW, MS

Gamete retrieval after death or irreversible coma ought not to be counted among the many acceptable practices of assisted reproductive technology (ART) because the donor patient’s consent cannot be reasonably verified and there is no possibility to participate in childrearing activities. Although it is possible a case could arise where the patient leaves clear and convincing evidence of the wish to have gametes harvested following a devastating loss of brain function, I will argue that advance directives are still inadequate and decisions will necessarily default to family members who may have complicated feelings and agendas. In terms of intent, the absence of any ability to participate in childrearing should be taken into consideration when evaluating decisions about harvesting gametes from comatose or deceased patients, again placing the decision with the family members who must accept and accommodate these preferences.  Allowing such a practice affirms the irrelevance of participating in rearing one’s offspring, and this may be lead to a slippery slope of diminishing the importance of responsibility in childrearing activities. 

Advance directives provide some insight into what a patient may have wanted in terms of life sustaining treatment and perhaps allocation of organs and/or gametes. To harvest gametes from an individual who will not be able to affirm their intent to serve as donors for a partner may be morally uncomfortable for physicians. Performing a procedure to extend the reproductive liberty of a patient who will never have a role in any resulting child’s life may understandably challenge a provider’s beliefs about how far medicine ought to go in honoring patient or family requests. The role of surrogate decision makers for a patient who lacks capacity is to honor the spirit of advance directives, if not the exact specifications.  Honoring the autonomy of a patient, however; need not extend to the realm of unfulfilled life goals. A patient who stated they wished to donate organs would still have such a request reviewed and consent is sought from the family members in nearly all cases.  Beyond the consideration due the patient, we may also have an obligation to If  we trust the patient’s intent and permission to retrieve gametes after loss of consciousness, can we fully trust the recipients motives are not influenced by grief or secondary gain, such as disability benefit or estate distribution?

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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