RESUMEN
This comprehensive review delves into the moral and ethical dilemmas surrounding post-mortem sperm retrieval (PMSR) and its implications for creating new individuals. The paper examines the challenges posed by unusual requests for sperm retrieval from the deceased's widow and parents, as well as the broader socio-ethical considerations associated with PMSR. These requests have often been denied due to the absence of established laws and guidelines governing posthumous sperm retrieval and subsequent births, which were once deemed impossible. While some countries have implemented institutional policies to regulate its use to some extent, there remains a lack of standardized rules and procedures for the collection and retrieval of sperm after death. It is essential to introduce institutional guidelines to facilitate requests for assisted reproductive technology (ART) following successful sperm retrieval. Additionally, the development of PMSR legislation is necessary to ensure a proper balance between the moral rights and fundamental rights of the deceased, their family, and any current or future offspring, while providing adequate protection for all parties involved.
Asunto(s)
Recuperación de la Esperma , Humanos , Masculino , Recuperación de la Esperma/ética , Recuperación de la Esperma/legislación & jurisprudencia , Concepción Póstuma/ética , Concepción Póstuma/legislación & jurisprudencia , Técnicas Reproductivas Asistidas/ética , Técnicas Reproductivas Asistidas/legislación & jurisprudenciaRESUMEN
Medically-assisted-procreation via in vitro fertilization, an integral part of of the so-called "reproductive revolution", is a valuable option for couples with sterility or fertility issues. That has however brought about three relevant results: the rift between procreation and sexual intercourse, the opportunity to use heterologous fertilization through donated gametes, and the ensuing increase in the number of "reproductive contributors" (male and/or female gamete donors, surrogate mothers). In Italy, Law n. 40 has put in place several restrictions, stricter than in most other European countries. Before being declared partly unconstitutional, Law 40 used to impose an array of bans and restrictions other than the ones still currently in force, such as the still unchanged prohibition to use human embryos for experimentation purposes and the ban on surrogacy. For same-sex couples who travel abroad to get around the Italian ban on heterologous fertilization, surrogacy, and MAP for homosexual couples. The authors have attempted to lay out a short analysis of how Italian courts have attempted to uphold the best interests of children born abroad in homosexual families, by taking into account the latest decisions on the subject.
Asunto(s)
Fertilización In Vitro/legislación & jurisprudencia , Niño , Embrión de Mamíferos , Europa (Continente) , Femenino , Células Germinativas , Humanos , Italia , Masculino , Donación de Oocito/legislación & jurisprudencia , Técnicas Reproductivas Asistidas/legislación & jurisprudencia , Recuperación de la Esperma/legislación & jurisprudencia , Madres SustitutasRESUMEN
OBJECTIVE: To evaluate the presence and content of policies on posthumous sperm retrieval at 75 major academic medical centers in the U.S. MATERIALS AND METHODS: We surveyed the top 75 major academic medical centers ranked for research in 2016 by U.S. News & World Report using a questionnaire-based telephone/web survey. We gathered data on the presence and content of posthumous sperm retrieval policies on the Internet. If not published, we contacted the legal counsel, the ethics and compliance offices, the urology department, as well as the infertility treatment center associated with each institution. In addition, we also surveyed members of the Society for Male Reproduction and Urology. RESULTS: We gathered data regarding posthumous sperm retrieval from 41 out of the 75 major academic medical centers. Of the 41 institutions, only 11 (26.8%) had policies regarding posthumous sperm retrieval. Out of those 11 centers, 4 required prior written consent, whereas the remaining 6 allowed for verbal or inferred consent from the surviving life partner. One policy prohibited the procedure. Five of the policies in this survey included a bereavement period. Of the 30 (73.2%) centers without policies, lack of legal guidance was cited as the most common barrier to policy adoption. CONCLUSION: Only a small proportion of major academic medical centers have policies on posthumous sperm retrieval. Medical centers can adopt individualized policies based on guidelines published by professional societies.
Asunto(s)
Política de Salud , Concepción Póstuma/legislación & jurisprudencia , Recuperación de la Esperma/legislación & jurisprudencia , Encuestas y Cuestionarios , Centros Médicos Académicos , Humanos , Masculino , Formulación de Políticas , Concepción Póstuma/ética , Medición de Riesgo , Estados UnidosAsunto(s)
Toma de Decisiones/ética , Concepción Póstuma , Recuperación de la Esperma/ética , Esposos , Criopreservación/ética , Femenino , Humanos , Consentimiento Informado/ética , Inseminación Artificial/ética , Masculino , Concepción Póstuma/ética , Concepción Póstuma/legislación & jurisprudencia , Embarazo , Preservación de Semen/ética , Recuperación de la Esperma/legislación & jurisprudencia , Obtención de Tejidos y Órganos/éticaAsunto(s)
Responsabilidad Legal , Mala Praxis/legislación & jurisprudencia , Errores Médicos/legislación & jurisprudencia , Servicios de Salud Reproductiva/legislación & jurisprudencia , Preservación de Semen , Bancos de Esperma/legislación & jurisprudencia , Recuperación de la Esperma/legislación & jurisprudencia , Humanos , Consentimiento Informado/legislación & jurisprudencia , Masculino , Medicina Reproductiva/legislación & jurisprudencia , Manejo de Especímenes , Estados UnidosRESUMEN
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.
Asunto(s)
Concepción Póstuma/ética , Concepción Póstuma/legislación & jurisprudencia , Recuperación de la Esperma/ética , Criopreservación , Europa (Continente) , Femenino , Fertilización In Vitro , Humanos , Consentimiento Informado , Masculino , Medicina Reproductiva/normas , Recuperación de la Esperma/legislación & jurisprudenciaRESUMEN
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.
Asunto(s)
Protocolos Clínicos , Política Organizacional , Concepción Póstuma , Medicina Reproductiva/legislación & jurisprudencia , Recuperación de la Esperma , Protocolos Clínicos/normas , Práctica Clínica Basada en la Evidencia/legislación & jurisprudencia , Práctica Clínica Basada en la Evidencia/métodos , Femenino , Humanos , Masculino , Concepción Póstuma/legislación & jurisprudencia , Concepción Póstuma/estadística & datos numéricos , Embarazo , Estándares de Referencia , Medicina Reproductiva/métodos , Medicina Reproductiva/organización & administración , Bancos de Esperma/legislación & jurisprudencia , Bancos de Esperma/métodos , Bancos de Esperma/organización & administración , Recuperación de la Esperma/legislación & jurisprudencia , Recuperación de la Esperma/normas , Recuperación de la Esperma/estadística & datos numéricos , Universidades/legislación & jurisprudencia , Universidades/organización & administración , Universidades/normasRESUMEN
Posthumous gamete (sperm or oocyte) procurement and reproduction are ethically justifiable if written documentation from the deceased authorizing the procedure is available. In the absence of written documentation from the decedent, programs open to considering requests for posthumous gamete procurement or reproduction should only do so when such requests are initiated by the surviving spouse or life partner. This document replaces the ASRM Ethics Committee report, "Posthumous reproduction," published in September 2004 (Fertil Steril 2004;82[Suppl 1]:S260-2).
Asunto(s)
Criopreservación , Comités de Ética , Recuperación del Oocito , Concepción Póstuma , Recuperación de la Esperma , Directivas Anticipadas , Formularios de Consentimiento , Consejo , Criopreservación/ética , Pesar , Humanos , Consentimiento Informado , Recuperación del Oocito/ética , Recuperación del Oocito/legislación & jurisprudencia , Padres , Concepción Póstuma/ética , Concepción Póstuma/legislación & jurisprudencia , Recuperación de la Esperma/ética , Recuperación de la Esperma/legislación & jurisprudencia , EspososRESUMEN
Death arrives always too soon, and most often unexpectedly, destroying our plans and the plans of the ones who love us. Medically assisted reproduction offers nowadays a technique that makes possible to have children from someone that recently passed away. Post mortem reproduction is not the satisfaction of a mere whim, but the continuity of strong love affections, and frequently provides some kind of fulfillment to the common aspiration of the couple in constituting a family. All around the world courts and law makers are profoundly divided in the legitimacy of this practice. The well being of the child to be and the respect for the dead person seem to be the strongest arguments against. But, as this study will show, none of them resist to a more careful scrutiny. Therefore, not only post mortem embryo transfer should be allowed, but post mortem insemination and fertilization should also be permitted.
Asunto(s)
Transferencia de Embrión , Técnicas Reproductivas Asistidas/legislación & jurisprudencia , Recuperación de la Esperma/legislación & jurisprudencia , Brasil , Criopreservación , Muerte , Femenino , Francia , Humanos , Masculino , PortugalRESUMEN
Post-mortem Sperm Retrieval (PMSR) is seldom requested in Australasia. The retrieval of sperm is permitted only by prior written consent or by order of the court. Sperm should be retrieved within 24 h following death; however, collection within 36 h may still be successful. The clinical response to such a request must be mindful of complex ethical and legal considerations. Clear, accessible and consistent law in this area would benefit medical, legal and societal stakeholders.
Asunto(s)
Fertilización In Vitro/legislación & jurisprudencia , Recuperación de la Esperma/ética , Recuperación de la Esperma/legislación & jurisprudencia , Directivas Anticipadas/ética , Directivas Anticipadas/legislación & jurisprudencia , Australasia , Fertilización In Vitro/ética , Humanos , Masculino , Guías de Práctica Clínica como Asunto , Recuperación de la Esperma/normas , Encuestas y Cuestionarios , Consentimiento por Terceros/ética , Consentimiento por Terceros/legislación & jurisprudencia , Factores de TiempoRESUMEN
The French law regulating assisted reproductive technologies forbids donor spermatozoa to be available in case of failed testicular sperm extraction (TESE) performed on the day of oocyte retrieval. This article reports the first French live birth after intracytoplasmic sperm injection of donated spermatozoa into frozen-thawed oocytes cryopreserved following failure of TESE. By reinforcing the relevance of TESE performed on the day of oocyte retrieval, oocyte cryopreservation in couples having beforehand consented to go to sperm donation will avoid cycle cancellation and potentially lead to successful live birth. Therefore, it could modify the French policy of management of patients suffering from non-obstructive azoospermia.
Asunto(s)
Azoospermia/terapia , Criopreservación , Oocitos , Inyecciones de Esperma Intracitoplasmáticas/legislación & jurisprudencia , Recuperación de la Esperma/legislación & jurisprudencia , Adulto , Femenino , Francia , Humanos , Masculino , Inducción de la Ovulación , Embarazo , Resultado del Embarazo , Técnicas Reproductivas Asistidas/legislación & jurisprudencia , Resultado del TratamientoRESUMEN
A follow-up study of the subsequent use of all postmortem frozen sperm samples during 2003-2010 is reported. Only the sister of one of the 10 unmarried deceased men was in contact with the bank. Four widows elected to discard the frozen sperm and all of the remaining spouses were uninterested in its fate. Because none of the samples were requested for use, the need for sperm procurement should be reconsidered.
Asunto(s)
Criopreservación , Concepción Póstuma , Preservación de Semen/métodos , Bancos de Esperma , Recuperación de la Esperma , Esposos , Adulto , Cadáver , Causas de Muerte , Femenino , Estudios de Seguimiento , Congelación , Conocimientos, Actitudes y Práctica en Salud , Política de Salud , Humanos , Israel , Masculino , Persona de Mediana Edad , Concepción Póstuma/legislación & jurisprudencia , Bancos de Esperma/legislación & jurisprudencia , Recuperación de la Esperma/legislación & jurisprudencia , Esposos/legislación & jurisprudencia , Esposos/psicología , Factores de Tiempo , Adulto JovenRESUMEN
INTRODUCTION: Assisted reproductive technologies are increasingly more present in our everyday life: from classical sperm/egg donation or in vitro fertilization to newer, more controversial methods such as surrogate motherhood, male pregnancies or posthumous sperm procurement. Every year, new concepts are emerging in this field and the medical world is not always prepared to deal with them. MATERIAL AND METHOD: The greatest problem of using posthumous sperm procurement as an assisted reproductive method resides in analyzing consent related. An extensive research of the scientific literature revealed eight possible situations which we will present and analyze in this article. RESULTS: By analyzing consent related issues we present a decision making algorithm for posthumous sperm procurement.
Asunto(s)
Consentimiento Informado , Recuperación de la Esperma , Obtención de Tejidos y Órganos , Algoritmos , Toma de Decisiones , Humanos , Consentimiento Informado/ética , Consentimiento Informado/legislación & jurisprudencia , Masculino , Concepción Póstuma/ética , Concepción Póstuma/legislación & jurisprudencia , Recuperación de la Esperma/ética , Recuperación de la Esperma/legislación & jurisprudencia , Espermatozoides , Donantes de Tejidos , Obtención de Tejidos y Órganos/ética , Obtención de Tejidos y Órganos/legislación & jurisprudenciaRESUMEN
Fertility assistance to HIV-positive men is now accepted practice in many parts of the world. We analyze the legislative, ethical, and clinical factors that explain the differences across continents with the aim of opening up the debate within the United States on whether clinics can justify denying HIV-infected men the opportunity of parenting through a now well-established risk reduction method with a proved safety record.
Asunto(s)
Descontaminación/métodos , Infecciones por VIH , Cooperación Internacional , Técnicas Reproductivas Asistidas , Recuperación de la Esperma , Separación Celular , Descontaminación/ética , Descontaminación/legislación & jurisprudencia , Descontaminación/normas , Transmisión de Enfermedad Infecciosa/ética , Transmisión de Enfermedad Infecciosa/legislación & jurisprudencia , Transmisión de Enfermedad Infecciosa/prevención & control , Femenino , Infecciones por VIH/transmisión , Infecciones por VIH/virología , Humanos , Cooperación Internacional/legislación & jurisprudencia , Masculino , Embarazo , Técnicas Reproductivas Asistidas/ética , Técnicas Reproductivas Asistidas/legislación & jurisprudencia , Técnicas Reproductivas Asistidas/normas , Técnicas Reproductivas Asistidas/estadística & datos numéricos , Recuperación de la Esperma/ética , Recuperación de la Esperma/legislación & jurisprudencia , Recuperación de la Esperma/normas , Espermatozoides/citología , Espermatozoides/virología , Reino Unido , Estados UnidosRESUMEN
DEFINITION OF THE PROBLEM: Due to new technological advances in assisted reproduction, perimortem sperm retrieval has developed into a subject of increasing interest for families of comatose or dying male patients in critical care facilities. These requests raise a number of medical, ethical, legal and psychological issues. ARGUMENTS AND CONCLUSIONS: The case of a comatose dying male patient is used to illustrate the variety of positions and problems which have to be discussed. The importance of written consent of the donor, the interest of the unborn child and the legal limitations are highlighted.
Asunto(s)
Recuperación de la Esperma/ética , Recuperación de la Esperma/legislación & jurisprudencia , Adulto , Niño , Coma , Cuidados Críticos , Muerte , Derechos Humanos , Humanos , Consentimiento Informado , Masculino , Autonomía Personal , Técnicas Reproductivas Asistidas/ética , Técnicas Reproductivas Asistidas/legislación & jurisprudencia , Técnicas Reproductivas Asistidas/psicología , Recuperación de la Esperma/psicologíaRESUMEN
In re Matter of Daniel Thomas Christy authorized post mortem gamete retrieval under the most recent revision of the Uniform Anatomical Gift Act. This article recommends that the National Conference of Commissioners on Uniform State Laws explicitly address the issue of post mortem gamete retrieval for reproductive purposes; that legislators specify whether their states will follow the Christy ruling; and that ethics committees and consultants prepare for the questions about human identity and self determination that post mortem gamete retrieval raises.
Asunto(s)
Donación Directa de Tejido/legislación & jurisprudencia , Concepción Póstuma/legislación & jurisprudencia , Recuperación de la Esperma/legislación & jurisprudencia , Adulto , Donación Directa de Tejido/ética , Femenino , Humanos , Consentimiento Informado/legislación & jurisprudencia , Iowa , Masculino , Donación de Oocito/legislación & jurisprudencia , Concepción Póstuma/ética , Recuperación de la Esperma/ética , Estados UnidosRESUMEN
Postmortem sperm retrieval has been used worldwide. Following retrieval, sperm can then be used (usually by the surviving partner) to produce a child related to the now-deceased male. This paper describes a request for postmortem sperm retrieval made by the family of a man who had suffered trauma leading to his death. The man had not given written consent for the retrieval and use of his sperm before his accidental death. The case illustrates some of the complex ethical and legal issues occurring in Canada and describes the new Canadian regulations, which prohibit postmortem sperm retrieval unless explicit written consent has been provided by the deceased.
Asunto(s)
Técnicas Reproductivas Asistidas/legislación & jurisprudencia , Preservación de Semen/ética , Recuperación de la Esperma/legislación & jurisprudencia , Autopsia/ética , Autopsia/legislación & jurisprudencia , Canadá , Criopreservación/ética , Humanos , Masculino , Técnicas Reproductivas Asistidas/economía , Técnicas Reproductivas Asistidas/ética , Recuperación de la Esperma/ética , Recolección de Tejidos y Órganos/éticaRESUMEN
The majority of the extensive debate surrounding posthumous sperm procurement (PSP) focuses on how to respect the deceased man and his autonomy. Policy and law also focus on the deceased's interests, specifying the level of consent required. This article argues (using four hypothetical fact situations) that consent should not be the sole focus of ethical debate. Instead, a fuller picture should be examined, including the wishes and values of the prospective sperm donor; the future life and prospects of the resultant child; the needs and motivations of the mother, and other pertinent factors. In practice, this means that a committee acting judicially should consider each case. This is a practical option for New Zealand and Australia where applications for posthumous sperm procurement are not common but it also enables us to consider the ethical arguments in relation to such determinations in other jurisdictions.