P-384 Advanced paternal age: a mapping of the ethical issues

Abstract

Abstract Study question What are the ethical issues raised by advanced paternal age? Summary answer Advanced paternal age is an ethically challenging phenomenon at the intersection of perinatal ethics, public health ethics, research ethics and policymaking. What is known already Although there is no clear indication on when begins advanced paternal age (APA), there is a tendency to consider 40 years old and over as a turning point in male reproduction. APA is now associated with several risks for male fertility, miscarriages, future child health and psychological development. Clinicians, scientists, social science researchers and ethicists have pointed several ethical issues raised by APA. For the moment, the scope of this discussion has not been fully assessed in a systematic way. Study design, size, duration To support a comprehensive evaluation of APA, we propose a mapping of the ethical issues of APA. Participants/materials, setting, methods First, we conducted a systematic literature review to identify ethical issues pointed by researchers and clinicians. Second, this first list of issues was discussed by a panel of experts (N = 23) through a web survey. The results from both data collections were triangulated by qualitative analysis into an integrated list of issues. Main results and the role of chance Six groups of issues emerged from data analysis. The first group relates to issues associated with the family project. In other words, how to balance the risks of APA with the benefits of the family project. The second group looks at the issues for healthcare professionals, i.e., how to support the family project while respecting the professional duty to protect their patients’ wellbeing. The third group refers to the gender justice issues and how APA generates inequities between gendered reproductive roles. The fourth group covers the public health dimension of APA and the justification to create intervention to respond to a collective and potentially intergenerational phenomenon. The fifth group is concerned about ways to develop sound and fair policies to respond to the challenges of APA. The sixth group encompasses research ethics issues on how to respectfully develop the field of research on APA. Limitations, reasons for caution APA is a burgeoning field of research, and it faces two principal limitations: (1) there is no clear understanding of the molecular mechanism of APA effect, and (2) data on the psychosocial dimension of APA is scarce. For these reasons, the ethical reflection is still speculative. Wider implications of the findings These findings offer a roadmap for future research on the ethics of APA. They provide a comprehensive understanding of issues that can be discussed during preconception counselling. At last, they suggest indications for the development of public health interventions or policies dedicated to address the most challenging aspects of APA. Trial registration number not applicable