Live Sperm Dead Bodies - Case Study Example

Introduction: Posthumous semen retrieval raises questions about consent, the respectful treatment of the dead body, and the welfare of the child to be. Metaphysically, the person disappears from his or her body at death, but the dead body continues to command respect. (3, 4) However, metaphysical issues are always in debate and their value and use in important matters such as this are called into question. Although most religions generally believe in the survival of the soul, few religions teach about the soul sufficiently clear for there to be any general agreement as to what the soul is or what happens to the soul after death. For example, Christians tend to believe that the body one has at death will rise again and live. So, the issue of sperm retrieval has bearing on the question many religious beliefs and the issue of the desecration of the body, In what follows, we will consider four issues related to the above case. We will ask, 1) What technical conditions are there for sperm retrieval, Does written consent need to be given, 3) re there cases that set a precedent for this and 4) if Bill's fiance objected to the use of the sperm, should it still be taken What technical conditions are there for sperm retrieval Sperm retrieval has advanced significantly since the advent of storing sperm in sperm banks. Initially, such storage required the male to masturbate and then the retrieved sperm would be stored in liquid nitrogen at - 70oC. When fertilization was desired, several cubic centimetres of semen were required in order to achieve artificial insemination. Today, vasal aspiration can be used to retrieve sperm or the scrotal wall can be punctured and used to aspirate leaking sperm into a nourishing fluid or medium. Also, a small scrotal incision could be made to remove sperm. Furthermore, a new, much more advanced procedure called intracytoplasmic sperm injection (ICSI) allows technicians to fertilise an egg using a single sperm cell injected directly into the egg. However, in any of these procedures, in vitro fertilization (IVF) will usually be required to achieve pregnancy with these extraction procedures. In the case of deceased individuals, the epididymis of the deceased can be removed and its contents stored in liquid nitrogen. Thus, the issue here is not one of technical difficulty or feasibility, but one of ethical, moral and religious issues. One central and crucial issue certainly would be defining death (5, 6). When is a person dead Even though we know death when we see it, many people have been revived minutes, even hours after meeting the criteria for death. Another concern is respect for the body of the deceased. For example, the surgical removal of the epididymis might be viewed as desecrating the body of the deceased even if he approves of it. Some religions, for example, forbid autopsies and the use of body parts even to save others. Does written consent need to be given This is a difficult gray area. Ethically, valid consent requires 1) that the patient have the capacity to make decisions, 2) that he or she have/be give adequate information and 3) that he give consent voluntarily without coercion. The prevalent view is that requests for a posthumous semen retrieval and fertilization should not be granted unless convincing evidence exists that the dead man desires for his widow to carry and bear his child. In general, it is best to have the written consent of the deceased sperm donor, but that is not entirely clear. At least two other legal forms of consent can be considered. For example, in some circumstances, "implied consent" may substitute for written consent or a formal consent discussion. Implied consent can sometimes be inferred from the prior actions of the deceased. Presumed consent is another form of consent (7). Rather than relying on a patient's actions or words, "presumed consent" is based on a theory of human goods (9). When the patient is unconscious or otherwise unable to provide his consent or express his wishes, a proxy may stand in to speak for the potential sperm donor. In some legal circles, the proxy is allowed to decide what is in the "best interests" of the prospective donor. The legal definition or standard of "best interest" is not clearly defined. Orr and Siegler refer to a hierarchy of factors that can be used when determining the ethical considerations of posthumous sperm donations and the subsequent fertilization. This hierarchy consists of a) a patient's current statement, b) an advance written directive, c) a previously reported statement, d) recognized values and e) presumed best interests. Ironically, it may also be possible to deny consent even when written or when the deceased has made his wishes to proceed with such a procedure clearly known. Autonomy is a bounded liberty in that a person's right to have what he or she desires clearly is not absolute (Orr and Siegler). Furthermore, the attending physician or physicians involved may freely decline to honour the patient's wishes (Orr and Siegler). Also, the welfare of the child is a factor. In England, the Human Embryology and Fertilization Authority of Great Britain (10) requires physicians to consider the welfare of the potential child in matter of this nature. Are there cases that set a precedent for this Orr and Siegler cite three cases (only two of which are related here) relevant to the issues raised here but both cases involve married rather than engaged individuals. In one case the couple was separated. A 28 year old man married for six years died of self inflicted gunshot wounds after becoming depressed after a marital separation. He was an only child. Before his death, his parents asked the intensive care physician to arrange for sperm retrieval after his death. They said they were certain he would have wanted his biological line to continue. When a clinical ethics consultant reviewed the situation, and after talking to his parents and his widow, the consultant was unable to elicit any substantiating evidence that the man would have wanted his widow to bear his child, so he recommended against the request for sperm retrieval. In another situation, a previously healthy 36 year old man contracted pneumonia that subsequently developed into adult respiratory distress syndrome requiring assisted ventilation. After 14 days of aggressive treatment, he developed multi-organ system failure and his wife was informed that he would not survive. She asked if semen could be collected so that she might bear his child. An ethics consultant determined that they had been unsuccessfully trying to have a child for over 10 years. Two months before his illness, the couple had seen an infertility specialist and were to begin in vitro fertilization with her next menstrual cycle. The wife believed he would want her to bear his child and the wellbeing of the child being raised by a single parent was unknown, but otherwise, the attending physicians, nurses and the ethics consultant felt that the available information adequately supported that the wife's requests also represented the presumed wishes of the deceased man. Both of these cases are taken from Orr and Siegler (1). If Bill's fiance objected to the use of the sperm, should it still be taken The question is, "Should the deceased individual's sperm be taken if his widow or fiance objects" Probably not. In cases of engagement/betroval, the legal situation and status of the woman is much the same as in the case of them already being married. In this case, the lady involved is a fiance, but this is similar to his wife, so we will focus on the question as if the couple were already married Law Professor Andrews (13) states that the practice of retrieving sperm from comatose or deceased men comes "perilously close to rape." In this respect, inseminating or implanting the fertilized egg in the uterine wall of the widow or fiance against her will, besides being both impractical and essentially impossible, would be more or less like rape, and inseminating other women would be like prostitution or adultery. Although in many countries, the law related to adultery views a wife's body to be the property of her husband, even a wife cannot be forced into sexual situations with her husband. In addition, a difficult pregnancy could put the woman's life at risk. If so, this could result in any one of three different undesirable outcomes. The child could die in utero or at birth, the wife or fiance could die in childbirth leaving the child as an orphan or both the wife and child could die as a result of childbirth. A fourth undesirable alternate is that the child could be born deformed or mentally retarded either with the mother to care for it or with her dying in childbirth. None of these situations would be desirable. Obviously, none of these situations would be in the best interest of the child and since both prostitution and adultery are illegal, sperm taken posthumously from a married or engaged man against the will of his widow or fiance raises a litany of legal, ethical and religious issues that speak against such action. The bottom line in this matter is that the wife's or fiance's consent should probably be given before all other matters even if it has been clearly established that the deceased husband or fianc has consented to be a sperm donor for his wife or fiance. When her husband or fiance dies, his wife's body is totally her own property, at least in many countries. Even when he was alive, many countries (but not all) do not allow a man to force his sexual favours and desires on his wife/fiance. Likewise, prostitution and adultery are illegal in most countries. The bottom line is that Bill's fiance should be consulted. Even so, the attending physicians can refuse to perform the procedure. Summary and Conclusion: Considering the scenario given with Bill and his fiance, it is probable that posthumous semen retrieval for subsequent in vitro fertilization would be denied. There is insufficient evidence that Bill would have desired it and it would certainly be unethical to force his fiance into the situation even if it were possible. Coercion might possibly force her to do it against her will, but that would certainly be unethical. Barring coercion, there would be no other way to force her into being a party to the in vitro fertilization procedure, and fertilizing other women could be viewed as prostitution or adultery. The adultery issue is a legal gray point since the couple are engaged rather than married, but it would still be ethically unsound. References: 1. Orr, R. D. and Siegler, M. (2002). Is posthumous semen retrieval ethically permissible Journal of Medical Ethics, 28:299-302. 2. Turek, Paul J. (2001). Sperm Aspiration Procedures for Male Infertility. Male Reproductive Laboratory, University of California at San Francisco. 3. May W. (1973). Attitudes toward the newly dead. Hastings Center Report, 1, 3-13. 4. Iserson K. V. (1994). Death to dust. Tuscon, AZ: Galen Press, 138. 5. Kimura R. (1991). Japan's dilemma with the definition of death. Kennedy Institute of Ethics Journal, 1, 123-31. 6. Shewmon D. A. (1998). Brainstem death', brain death', and death: a critical re-evaluation of the purported equivalence. Issues in Law & Medicine, 14, 125-45. 7. Cohen C. (1992). The case for presumed consent to transplant human organs after death. Transplantation Proceedings, 24, 2168-72. 8. Childress JF. (1982). Who should decide: paternalism in health care. New York: Oxford University Press, 82-3. 9. See reference 8: 83-5. 10. The Human Fertilisation and Embryology Act 1990 (England): ch 37. 11. Orr, R. D. (1997). Gundry SR, Bailey LL. Reanimation: overcoming objections and obstacles to organ retrieval from non-heart-beating cadaver donors. Journal of Medical Ethics, 23, 7-11. 12. Kahan S. E., Seftel A.D. and Resnick M.I. (1999). Postmortem sperm procurement: a legal perspective. Journal of Urology, 161, 1840-3. 13. Andrews, L. B. (1999). The sperminator. The New York Times Magazine Mar 28: 62-5. Read More