Ethical Considerations in Post-Mortem Sperm Retrieval: A Comprehensive Review.

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.

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)

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.

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.

Posthumous conception: Recent legal developments in South Africa.

Posthumous conception - when a deceased person's gametes are used for procreative purposes - made its debut in South African (SA) courts in NC v Aevitas Fertility Clinic. A widow was granted the right to use her deceased husband's sperm for procreation. Against the background of legislative ambiguity, this case creates legal certainty that posthumous conception is legally permissible in SA - at least where deceased persons provided written consent that their gametes can be used by their surviving spouses or life partners after their death, and where there is no controversy about such consent.

Posthumous retrieval and use of gametes or embryos: an Ethics Committee opinion.

Posthumous gamete (sperm or oocyte) retrieval or use for reproductive purposes is ethically justifiable if written documentation from the deceased authorizing the procedure is available. Retrieval of sperm or eggs does not commit a center to their later use for reproduction, but may be permissible under the circumstances outlined in this opinion. Embryo use is also justifiable with such documentation. In the absence of written documentation from the decedent, programs open to considering requests for posthumous use of embryos or gametes should only do so when such requests are initiated by the surviving spouse or partner. This document replaces the report of the same name, last published in 2012.

Reproductive function: the protection of the rights of the people which are sent to the area of the fighting.

OBJECTIVE: Introduction: The issues of problems of the legal regulation of posthumous reproduction in Ukraine and foreign countries are analysis in the article. The author substantiates the necessity in the creation and acceptance of the State Program of the retrieval of reproductive cells in people who are sending to the area of the fighting. The aim:the purpose of our work is a comprehensive study of post-mortem (post-mortem) reproduction and substantiation of the possibility and necessity of adopting a state program for the selection of reproductive cells of individuals who are sent to a combat zone to ensure their full social protection and assistance in the realization of the right to fatherhood or motherhood. PATIENTS AND METHODS: Materials and methods: the experience of certain countries is analyzed in the research. Additionally, we used statistical data of international organizations, conclusions of experts and foreign legal acts dealing with posthumous reproduction and auxiliary reproductive technologies, judicial practice, doctrinal ideas and views on this issue. RESULTS: Review: there are medical (practical) preconditions for the introduction of posthumous reproduction programs. Among them is the technology of obtaining reproductive cells (post-mortem too), their preservation and successful subsequent use. In addition, foreign experience shows the success of the application of these technologies and the real guarantee of full implementation of the range of rights to the family, fatherhood or maternity. CONCLUSION: Conclusions: we note the urgent need to develop and adopt a state reproductive cell selection program for individuals who are sent to the combat zones (according to a model that exists in such countries as the USA and Israel).

Policy on Posthumous Sperm Retrieval: Survey of 75 Major Academic Medical Centers.

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.

Mapping French people's views regarding posthumous reproduction.

OBJECTIVE: The study mapped French people's views regarding the acceptability of posthumous reproduction. BACKGROUND: Posthumous reproduction - the use of a deceased person's gametes for procreative purposes -is a controversial procedure because it involves a series of ethical issues, namely the surviving partner's rights to procreation, the emotional feelings and financial interests of other family members, and the government's interest in maintaining orderly inheritance rules. METHODS: A convenience sample of participants aged 19-68 (104 lay people, 47 health professionals and 15 lawyers) were presented with 48 realistic stories that were composed according to a four-factor within-subject design: marital status (married for about 10 years with children, married for about three years without children, and cohabiting for three years without children) × attitude of the deceased's parents (favourable vs. unfavourable to posthumous procreation) × time elapsed since the partner's death (three months vs. nine months) × deceased's wishes (written consent, oral consent given in front of credible witnesses, unknown wishes, and unfavourable attitude). RESULTS: Through cluster analysis, four qualitatively different positions were found. They were called Never Acceptable (35% of the sample, mostly health professionals, lawyers and regular attendees to the church or temple), Tolerable in a Few Cases (28%), Depends on Deceased's Wishes (22%, mostly lay people) and Quite Acceptable (16%, mostly lay people). CONCLUSIONS: About half of French lay people view the current legislation regarding posthumous assisted reproduction in a country such as the UK as more appropriate than the French legislation.

"Let Me Keep My Dead Husband's Sperm": Ethical Issues in Posthumous Reproduction.

The feasibility of posthumous reproduction when the surviving partner is female has brought to light many ethical, moral, social, and legal issues. This review aims to summarize these issues and to assist clinicians who may be faced with such requests. A question list, used for health technologies assessment, was utilized in a question-answer approach as the review methodology. Of the 1,208 publications identified through a comprehensive literature search in biomedical, psychological, and ethical databases, 31 articles included arguments related to one or more questions from the predefined question set. Key stakeholders identified include the deceased, the requesting party, the resultant child, the physician, and society. Key ethical issues relevant to posthumous reproduction include the four traditional pillars of medical ethics--autonomy, beneficence, nonmaleficence, justice--as well as the stakeholders' rights and sociocultural attitudes. The ethical framework formulated by these issues has been incorporated in a clinical ethics decision-making tool that could prove useful to clinicians and decision makers.

Posthumous Reproduction (PHR) in Israel: Policy Rationales Versus Lay People's Concerns, a Preliminary Study.

Israeli policy concerning PHR has been decided upon in an expertocratic manner, leaving the voice of the public unheard. Based on 26 semi-structured in-depth interviews with 13 Jewish-Israeli young couples, this preliminary study provides the first empirical data regarding lay attitudes toward PHR in Israel. Findings suggest major dissimilarities between the policy and lay people's wishes and rationales. While policy is built on the "presumed wish" assumption, supposing all men living in a loving relationship wish to have their partner carry their child post-mortem, this was empirically unsupported. However, the findings suggest that many interviewees were willing to defer to their surviving spouse's wishes to have their post-mortem child, sometimes even against their own wish, indicating a support for presumed consent. Respecting the wishes of the dead, a dominant argument in the bioethical discussion in Israel and beyond, was mainly irrelevant to informants, whereas interviewees considered the future child's welfare, a concern overlooked by Israeli policy. Likewise, while posthumous grandparenthood is on the rise in Israel, it clearly contradicts the wishes of the majority of this study's informants. Nonetheless, existing policy is not expected to raise any opposition, due to the extreme liberalism of the participants and their support of reproductive autonomy.

Perimortem gamete retrieval: should we worry about consent?

Perimortem gamete retrieval has been a possibility for several decades. It involves the surgical extraction of gametes which can then be cryo-preserved and stored for future use. Usually, the request for perimortem gamete retrieval is made by the patient's partner after the patient himself, or herself, has lost the capacity to consent for the procedure. Perimortem gamete retrieval allows for the partner of a dead patient to pursue jointly held reproductive aspiration long after their loved one's death. But how can we know if the dying patient would have consented to gamete retrieval? In the UK, consent is a legal necessity for storing or using gametes-but this is not always enforced. Moreover, although the issues related to posthumous reproduction have been discussed at length in the literature, few commentators have addressed the specific question of retrieval. Gamete retrieval is an invasive and sensitive operation; as with any other intervention performed on the bodies of dead or dying patients, the nature and justification for this procedure needs to be carefully considered. In particular, it is important to question the idea that consent for such an intervention can be inferred solely from a person's known wishes or plans concerning reproduction.

A discussion supporting presumed consent for posthumous sperm procurement and conception.

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.

Responding to Requests for Assisted Reproductive Technology Intervention Involving Women Who Cannot Give Consent.

One of the plots of the Canadian science fiction thriller Orphan Black involves a scheme to create dozens of siblings by harvesting the eggs of one woman, fertilizing them with the sperm of a single man, and implanting them for gestation in dozens of apparently willing surrogates.¹ The casualness of the procedure speaks to how comfortable we have all become with reproduction by technology. Yet there are still aspects of this process that remain outside the normative boundaries of most of our worldviews. This article considers recent advances in assisted reproductive technology (ART) that can result in a viable, fertilized embryo even when the mother is herself either permanently unconscious from a severe injury or has actually lost all brain function and therefore meets the legal criteria for brain death. It reviews these advances and applies them to four scenarios, or vignettes, that represent different concerns about the prospective mother's intent to reproduce before losing her ability to give consent.

[POST MORTEM PATERNITY]. / LA PATERNITÉ POST MORTEM.

Post mortem paternity, namely the procreation after the death of the man whom is part of the couple, is one of the questions which raised the most hesitations since the first bioethics laws of 1994. The National Assembly, encouraged by several opinions of the CCNE (National advisory committee of ethics) had let itself convince that the transfer had, at least, to be authorized in utero embryos preserved at the regard of which no one could not claim to have rights equal or higher than those of the woman concerned. However, the Senate always ended up obtaining the maintenance of an absolute prohibition of posthumous procreation (starting) from the spermatozoids or frozen embryos. This indifference with the cruelty of the application of the law to the women plunged into mourning--based on a paradoxical appreciation of the interest of the child not to be born orphan, and on a not very glorious taking into account of the interest of the Body of notaries not to change its practices--is particularly debatable. One can, nevertheless, try to understand it according to the obsession of the legalization of surrogate motherhood by application of the principle of nondiscrimination which could justify the requests of the men who, thanks to a surrogate mother, would wish to become fathers starting from gametes or embryos taken or created before the death of their wife or partner.

Sobre la nueva Ley de Reproducción Humana Asistida / No disponible

No disponible