“Shared risk”: Reframing risk analysis in the ethics of novel male contraceptives,

Abstract

Novel male contraception has the potential to enhance reproductive autonomy for men [ 1 Campo-Engelstein L. No more larking around! Why we need male LARCs. Hastings Cent Rep. 2011; 41: 22-32 Crossref PubMed Scopus (6) Google Scholar , 2 Martin C.W. Anderson R.A. Cheng L. Ho P.C. van der Spuy Z. Smith K.B. et al. Potential impact of hormonal male contraception: cross-cultural implications for development of novel male preparations. Human Reprod. 2000; 15: 637-645 Crossref PubMed Scopus (174) Google Scholar , 3 Heinemann K. Saad F. Wiesemes M. White S. Heinemann L. Attitudes towards male fertility control: results of a multinational survey on four continents. Human Reprod. 2005; 20: 549-556 Crossref PubMed Scopus (147) Google Scholar , 4 Glasier A.F. Anakwe R. Everington D. Martin C.W. van der Spuy Z. Cheng L. et al. Would women trust their partners to use a male pill?. Human Reprod. 2000; 15: 646-649 Crossref PubMed Scopus (148) Google Scholar ] and offer greater equity in contraceptive responsibility for monogamous or non-monogamous heterosexual relationships [ [1] Campo-Engelstein L. No more larking around! Why we need male LARCs. Hastings Cent Rep. 2011; 41: 22-32 Crossref PubMed Scopus (6) Google Scholar ]. However, novel male contraceptives have been in development for decades, with no method able to reach the market to-date. Technical challenges inherent in the development of novel reversible male contraceptives have been detailed in other publications [ 5 Thirumalai A. Page S.T. Recent developments in male contraception. Drugs. 2019; 79: 11-20 Crossref PubMed Scopus (19) Google Scholar , 6 Plana O. Male contraception: Research, new methods, and implications for marginalized populations. Am J Mens Health. 2017; 11: 1182-1189 Crossref PubMed Scopus (16) Google Scholar ]. The negative impact of gender bias in this setting has also been explored [ [1] Campo-Engelstein L. No more larking around! Why we need male LARCs. Hastings Cent Rep. 2011; 41: 22-32 Crossref PubMed Scopus (6) Google Scholar ]. Moreover, medicolegal issues have presented enormous challenges in female contraception development, leading to the discontinuation of some approved products. Similar concerns are likely to affect the development of novel male contraception, which is thus far unexplored and will require further analysis. For our purposes here, we will focus on one of the key ethical challenges in this domain. How ought medical professionals and researchers assess the balance of nonmaleficence (do no harm or avoid risks) and beneficence (seek the greatest good or benefit) [ [7] Beauchamp T.L. Childress J.F. Principles of biomedical ethics. Oxford University Press, New York2012 Google Scholar ], when male contraception has impacts that extend beyond the user of the contraceptive?