Protocols for posthumous fatherhood

Abstract

We note with interest the article on postmortem parenthood, (1Batzer F.R. Hurwitz J.M. Caplan A. Postmortem parenthood and the need for a protocol with posthumous sperm procurement.Fertil Steril. 2003; 79: 1263-1269Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar) and of its failure to take into account previous discussions of the same issues (2Bahadur G. Death and conception.Hum Reprod. 2002; 17: 2769-2775Crossref PubMed Google Scholar, 3Aziza-Shuster E. A child at all costs posthumous reproduction and the meaning of parenthood.Hum Reprod. 1994; 9: 2182-2185PubMed Google Scholar, 4Strong C. Gingrich J.R. Kutteh W.H. Ethics of sperm retrieval after death or persistent vegetative state.Hum Reprod. 2000; 15: 739-745Crossref PubMed Scopus (50) Google Scholar, 5Bahadur G. Posthumous assisted reproduction (PAR) cancer patients, potential cases, counselling and consent.Hum Reprod. 1996; 11: 2573-2575Crossref PubMed Scopus (24) Google Scholar). We suggested caution regarding posthumous reproduction, given the haste with which widows expressed their interest in progressing with insemination, when in reality no insemination occurred. Therefore, regarding point 5, we suggested a period of 9 months, but with greater experience, a 12 months' grace period would be preferable. Any longer time lapse may be misconstrued as unreasonable to the widow's autonomy. A time limit for storage ought to be stipulated which in the U.K. is 10 years from the date of storage. Most potential cases of posthumous insemination are associated with patients choosing to preserve their fertility before cancer treatment, in our experience. In their conscious state they will be able to make an informed choice, and by U.K. law events after death or mental incapacitation needs to be fully covered at the time of sperm storage. Point 1, therefore, gives rise to the possibility of complex tensions between written informed consent and reasonably inferred consent. Point 2 presents difficulties as adolescents seeking to store sperm are able to make adult-like decisions and give consent. A universally problematic area is one in which a mentally handicapped person storing sperm has to provide informed and effective consent. Point 4 does not give clear directions regarding HIV testing and its 6 months' quarantine and retest requirement. The HIV testing is routinely performed in conjunction to cryopreservation of gametes. Point 9 is compatible with our HFEAct 1990 (2Bahadur G. Death and conception.Hum Reprod. 2002; 17: 2769-2775Crossref PubMed Google Scholar). In conclusion, counseling support throughout is hugely important and beneficial to the surviving partner and promotes meaningful decision making. It is important to devise and to adopt protocols and procedures on a national level, to achieve consistency in the decision-making process. The consideration of the welfare of the child is paramount, especially if that child is at risk of not being considered an equal to any existing children. Inheritance issues are complex and require further debate. In the absence of written information, it should be noted that the deceased too have reproductive rights, in so far as posthumous reproduction may alter the contours of their lives, when living, and the way in which they may be remembered after death. Respect for the deceased will be promoted by respecting his or her wishes, as expressed in their written consent. Reply of the AuthorsFertility and SterilityVol. 81Issue 1Preview Full-Text PDF