Morning Symposium - MHPG Symposium - Blurring the Line Between Life and Death: The Psychological, Ethical and Legal Issues of Posthumous Reproduction

Date:October 21, 2014

Time:11:15 am - 1:00 pm

Location:HCC312 - Hawaii Convention Center

Presenters

Angela K. Lawson, Ph.D. (Chair), Northwestern University

Julianne E. Zweifel, Ph.D., University of Wisconsin

Nidhi Desai, J.D., Private Practice, Illinois

Needs Assessment and Description
Assisted reproductive technology (ART) practitioners routinely offer embryo and oocyte/sperm cryopreservation services to patients and couples who are interested in future family-building. Unfortunately, some patients, whether due to disease or accident, die after cryopreserving their genetic material. In the event of a patient’s death, their partner or other family members may desire to use those materials to achieve pregnancy. However, posthumous reproduction (reproductive attempts after the death of a partner) has resulted in a number of legal and ethical issues regarding pre-death consent from the deceased patient and ambiguous legal and social status for the resulting child(ren).

Multiple psychological issues also arise during the course of posthumous reproduction. These include decision-making in the context of grieving the death of a loved one, experiencing family disagreements about posthumous reproduction, and coping with potential pregnancy-related adverse events. Further, it is unknown what, if any, psychological burden posthumously conceived children or their family members will bear as the child grows. From a legal standpoint, it is often unclear as to who has the rights to these gametes or embryos, and what action an ART practitioner can or should take to release them to an interested family member. Furthermore, myriad issues arise concerning the child’s parentage and legal status. Because of the psychological, legal, and ethical concerns regarding posthumous reproduction, many practitioners have concerns about facilitating such treatment. This live course will address the psychological, ethical, and legal issues in posthumous reproduction and will provide direction to providers about how to address these issues with surviving family members.

Learning Objectives
At the conclusion of this session, participants should be able to:

  1. Discuss the history, definition, and types of posthumous reproduction.
  2. Sensitively explore the psychological issues related to posthumous reproduction with patients who freeze their gametes, and with surviving family members who return to use those gametes in the event of the patient’s death.
  3. Identify unique ethical and legal issues when discussing posthumous reproduction with patients who freeze their gametes, and with surviving family members who return to use those gametes in the event of the patient’s death.

ACGME Competency
Patient Care Interpersonal and Communication Skills
Professionalism

TEST QUESTION
After 2 years of trying to conceive, a 37-year-old woman and her 45-year-old husband with no children undergo their first cycle of in vitro fertilization (IVF). The couple does not get pregnant following the transfer of 2 fresh embryos. While the couple is preparing to undergo a frozen embryo transfer, the female partner is diagnosed with advanced brain cancer and subsequently dies. Her husband returns to the fertility clinic 1 month after her death to discuss having the deceased patient’s sister serve as a gestational carrier to conceive a child with the remaining frozen embryos.

After participating in this session, I will do the following in my practice:
a. Decline to work with the patient as they are requesting posthumous reproduction.
b. Counsel the patient in the same way as I would any patient undergoing treatment with frozen embryos.
c. Inform the patient that there are no potential legal concerns regarding posthumous reproduction.
d. Discuss with the patient the unique psychological and ethical issues associated with posthumous reproduction and refer them for legal consultation.
e. Inform the patient that posthumous reproduction is morally wrong and encourage them to destroy or donate the cryopreserved embryos.
f. Not applicable to my area of practice

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