What are the issues in post-mortem sperm retrieval?

Bioedge

Michael Cook

In 2010 21-year-old Niklas Evans was assaulted outside a bar in Texas. He ended up in a coma and died after 10 days. His heartbroken mother, Missy Evans, requested the hospital to retrieve her son’s sperm so that she could create a grandchild with a surrogate mother. The case was too controversial for American fertility clinics so she ended up travelling to South Africa.

Did Missy and her doctors act ethically in removing sperm from Niklas’s dead body without his consent? This is the question that Anna Smajdor, of the University of East Anglia, tackles in the Journal of Medical Ethics, based on a discussion of some cases which have occurred in England. Like many other bioethicists, she opposes it.

The dead still have interests. The logic of post-mortem sperm retrieval without explicit consent could be extended to many other issues,  like organ extraction, exhibition of the body, probate law and so on. Legally speaking, much more than a child is at stake.

The validity of inferred consent is a dangerous principle. “In medicine generally, consent for procedure X cannot be inferred from someone’s previous beliefs about situation Y,” she writes. If men knew what was involved in electro-ejaculation, they might well refuse their consent, even if they did express a wish to have children.

Proxy consent for one’s own benefit is a dangerous principle. She writes: 

Relatives can agree to donate a loved one’s tissue, but they cannot demand access to that tissue for themselves. The reasons for this are straightforward. Human tissues and organs are valuable commodities. This means that the bodies of dead and dying patients are vulnerable to exploitation. If the person testifying as to the patient’s wishes and providing proxy consent is alsothe one who stands to gain from the tissue that is made available, there is a clear conflict of interest.

The desire for offspring is not sufficient reason. From a woman’s ardent desire for a child one cannot infer consent. “Couples’ reproductive decisions are not necessarily based on symmetrical and equally held desires … It is risky and unjust to assume that one partner’s reproductive desires can be inferred from those of the other. And if this is the case in the living, it is still more so in the case of the dead or dying, who cannot articulate their dissent.”

Smajdor makes two specific recommendations. First, that the rules for posthumous gamete donation be tightened. Second, that the discretionary authority of the UK’s fertility watchdog, the Human Fertilisation and Embryology Authority, be rescinded so that it cannot permit the export of gametes obtained without consent.


cclicense-some-rightsThis article is published by and BioEdge.org under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation to Bioedge. Commercial media must contact us for permission and fees. Some articles on this site are published under different terms.

New Zealand Green Party will force referral for abortion for non-medical reasons

Sean Murphy*

The Green Party of New Zealand has published a position paper that includes a number of statements concerning abortion in the country.  The paper notes that the law now requires that abortion must be approved by two physicians on grounds that the procedure is necessary to preserve the woman’s mental or physical health or because of fetal disability. The party states that, since “99% of abortions are approved on ‘mental health’ grounds,” the current legal situation is ‘dishonest’.  This seems to be a frank admission that 99% of abortions are not, in fact, necessary to ensure mental or physical health.

If it forms a government, the party would decriminalize the procedure completely up to 20 weeks gestation, while continuing “current practice” beyond that point.  In addition, the position paper states that “to prevent coercion either for or against abortion,” it will:

Ensure medical oversight agencies, such as the Medical Council, maintain, publicise and enforce codes of ethics mandating that personal beliefs (including religious, political and moral) are protected, however the practitioner is required to refer the patient to a neutral practitioner in a timely manner.

Three points about this proposal are of interest.

First: it implies that a physician willing to provide an abortion is “neutral” with respect to the procedure, while a physician unwilling to do so is not.  This is incorrect.  To take a position either for or against the acceptability of abortion involves a moral or ethical judgement, just as a moral or ethical judgement is involved in stealing or refusing to steal.

Second: objecting physicians not infrequently refuse to facilitate morally contested procedures by referral because they believe that doing so makes them complicit in the act.  Demanding that they facilitate abortion by referral is not protective of their freedom of conscience or religion.

Third: if the paper is correct in asserting that  no medical grounds exist for “99%” of abortions now taking place in New Zealand,  there would seem to be no reason to compel objecting physicians to refer for the procedure.

Fundamental freedoms

 Why the right to conscientious objection must be restored

Presentation to the Life Dinner
Melbourne, Australia

David van Gend*

I feel a little out of place coming from Queensland to speak about the wretched situation in Victoria: coming from a State where it is always sunny, where the people are always nice, and where we don’t have oppressive laws that try to compel the conscience of free citizens.

But we are all in this together: an assault on fundamental freedoms in one State will become a precedent for similar abuses in other States.

Uncivil society

It was a Melbourne man, Julian Savulescu, now an ethics professor at Oxford, who declared that doctors who will not provide abortion should be “punished through removal of license to practice”. He wrote in the British Medical Journal in 2006:

A doctors’ conscience has little place in the delivery of modern medical care. What should be provided to patients is defined by the law… If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors.1

Crucial to his argument is that, “when society has already decided that a service is legal”, it is not for doctors to “compromise the delivery of services”. When Savulescu’s article was discussed in 2006 in the medical newspaper Australian Doctor, I was given as an example of the sort of doctor who, in his view, “should either get out of the specialty or the profession altogether.”2  I gave a different angle to Australian Doctor: that abortion as commonly practiced is not a medical service; it is a “medical abuse” which doctors are bound by their Hippocratic principles and humane conscience not to commit.

And no law, no professional board, has the authority to compel any doctor to violate the principles of their vocation or mutilate their own conscience by collaborating in intentional killing.

Yet in Victoria, under section 8 of the Abortion Law Reform Act 2008,3 that compulsion by the authorities is exactly what doctors and nurses face.

Not long ago society was a little more civil and did not contemplate using the force of law to compel the conscience of fellow citizens. . . [Full text]

Top employment strategies for discouraging conscientious objection

Bioedge

Xavier Symons

In a recent Journal of Medical Ethics article, controversial bioethicist Francesca Minerva argues for limiting the number of conscientious objectors in Italian hospitals.

Minerva asserts that conscientious objection “prevents access to certain treatments”, and proposes that we set up disincentives for objectors in hospitals. The proposed solutions include offering higher salaries for non-objectors and establishing ‘conscientious objector quotas’. She concludes:

When conscience-related issues prevent access to a certain treatment, such as abortion in Italy, the public health system, or the Ministry of Health in this case, has to find a solution that safeguards and protects the health of the patients as a priority.

In a response to Minerva, Oxford theologian and ethicist Roger Trigg argues that conscientious objection is a necessary part of the practice of medicine:

Once we discount conscientious moral reasoning, medicine is reduced to a technical issue about procedures, without any regard to their effect on the greater human good.

In the case of abortion, he suggests that high rates of conscientious objection might indicate a need to reconsider the original policy:

One problem with abortion is that for the most part those making the political decision are not those who have to implement the policy. If the latter object in sufficiently high numbers to make the policy hard to implement, that might be a reason for assuming there could be something wrong with what was being proposed.


cclicense-some-rightsThis article is published by Xavier Symons and BioEdge.org under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation to Bioedge. Commercial media must contact us for permission and fees. Some articles on this site are published under different terms.

RCOG faculty bars prolife doctors from receiving its degrees and diplomas

 Dr. Peter Saunders*

Doctors and nurses who have a moral objection to prescribing ‘contraceptives’ which act by killing human embryos are to be barred from receiving diplomas in sexual and reproductive health even if they undertake the necessary training according to new guidelines.

Under new rules issued by the Faculty of Sexual and Reproductive Health (FSRH) earlier this year these doctors and nurses are also to be barred from membership of the faculty and from specialty training.

The FSRH is a faculty of the Royal College of Obstetricians and Gynaecologists established on the 26th March 1993 as the Faculty of Family Planning and Reproductive Health Care. In 2007 it changed its name to the Faculty of Sexual and Reproductive Healthcare. [Full Text]