Mother's Request for Posthumous Sperm Retrieval: What Would Be Your Ethical Decision?

The Case Study in the January-February 2014 issue of the ethics journal "The Hastings Center Report" sets an ethics issue which, though not a major issue like assisted suicide for the terminally ill, nevertheless has occurred. The issue is that of sperm retrieval promptly after a patient is pronounced dead for later insemination in an attempt to create a child but without the specific documented request by the patient.  With a prior request made by the patient, certainly outside the various religious views and within the "Western" culture, this act could be ethically  acceptable. But in the case developed by the ethics journal, the mother of her 29 year-old son now virtually dead by neurological criteria ("brain dead") , and the mother as  his legal surrogate, requests the sperm retrieval, for future use, on the basis of, in the past,  her son's telling her that he "wanted to give her grandchildren." Neither the son's girlfriend nor the son's father was not involved in the mother's decision and request and, in fact, no one was specified as the recipient for later fertilization.  There was no written directive by the son requesting sperm retrieval.  My question for my visitors here is, if you called into the clinical situation as an ethicist, would you, with the history provided, tell the physicians faced with this request that it would be ethical to go ahead with the sperm retrieval?  One fact to consider is that organ retrieval such as kidneys for donation and transplant is considered legal and ethical if said by the family to have been requested by the patient. Do you see any difference between sperm retrieval and use and kidney donation and transplant? ..Maurice.

Addendum: For more information about posthumous sperm retrieval  read the Wikipedia article. You also may want to read the article "IVF AfterDeath" where through Google Images, the Graphic for this thread was obtained. Finally, come to your own ethical decision and post it here but then go ahead and read the free Case Study in The Hastings Center Report with the two commentaries.

Informed Consent: Does that Include Personal Detailing of Your Doctor?

There is still debate in the medical, ethical and legislative community as to how much information is enough as part of informed consent for the patient or the patient's surrogate to make a decision as to whether to have an operation or other procedure or medical treatment.  And is there such a thing as "too much information" for the patient to be told and expected to understand? That is still debatable. There is no debate as to the legal necessity for a patient's autonomous decision regarding their treatment but the question is "how much?" but also "what kind?"  For this thread I want to focus on a specific category of "what kind?" and that is: should the patient be permitted to ask personal questions about the doctor and followed by detailing by the doctor to the patient regarding the doctor as a person and as a professional. 

Lance K. Stell PhD, teacher-ethicist, has specified my focus with the following:

Traditionally, Informed Consent disclosure duties of the physician were “procedure focused” NOT provider focused.

Some states (e.g. Pennsylvania and North Carolina) have aggressively restricted statutory Informed Consent disclosures to the recommended procedure, and its alternatives, including the option of no procedure, along with a discussion of the risk/benefits of each option.

Other states have expanded the physician’s disclosure duty to

include the extent of his/her training and experience with the particular

operation (and the hospital's) when the outcome disparities between providers

for the proposed treatment were “material"

This development and entry of Big Data bids to expand disclosure duties (and

pressure on physicians to discuss) considerably. For a few examples:

How many of these procedures have you done, doctor? How many recently? What is

your Morbidity and Mortality Rate and your (and your hospital’s) 30-day unplanned readmission rate? Have you ever had a “never event?” You are proposing to do my operation laparoscopically, but suppose you find it necessary to “convert” to an open operation. Do your privileges include doing the procedure open, or must you call in a colleague who has such privileges for back up? What might be his/her responsibility or role in the setting of such “conversions?”

New rules give me a right to tell you my preferred manner of receiving health-related communication. So please, I prefer all information you give me about risk in statistical terms, not qualitative terms.

Tell me about your Conflicts of Interest. “I noticed that you're on the Federal Government’s list for having received payments from the medical products industry. Does that imply that you’re taking kick-backs or are under suspicion or something?”

 Tell me about the instrumentation you propose to use for my surgery. How big a profit does you hospital get on it? I support cost-effective care. Has any of it been implicated

in Device Problem reports to FDA? If so, have you considered using other instrumentation? Why not? And how are you compensated for your work? I strongly disapprove of "fee for service".

And, this is just the tip of…”By the way, when's the last time you got a good

night’s sleep?"

So when you go to the hospital for an appendectomy, about to start chemotherapy for a diagnosed cancer, are suggested "new" medication rather than the established drug for your illness, is there more you need to know beyond the lab tests, your doctors interpretation of your history, physical and labs? Do you also need to know also more about the personal details about your doctor?  And, if so, should you wait until you are immediately challenged to make an informed consent or should all this be part of the first selection of a doctor for your care? ..Maurice.

Graphic: Images from Google Images and modified by me using ArtRage.

Patient Modesty: Volume 63

As we start our sixty-third Volume, after reading all the descriptions of "criminality" inside the medical profession within the context of "patient modesty",  I just wondered, to start Volume 63 if we should really define what we are specifically referring to when we use the term "patient modesty". The other aspect of the expression which needs clarification is to whom does the term apply?  Does it apply to every human who is a patient,  including infants and children, to the elderly and demented and to those who are unconscious from anesthesia or in a permanent coma (persistent vegetative state) or, in fact, a patient who is dead?  I think we should all set an accepted definition of the term and to whom the term applies before we argue the case to those within the medical system in an effort to change the system to fully attend to the issues of patient modesty.  So let this be the goal of beginning this Volume.   I repeat, what exactly is "patient modesty" and to whom does it apply or, in fact, not apply? ..Maurice.

NOTICE: AS OF TODAY MARCH 18 2014 "PATIENT MODESTY: VOLUME 63" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 64

Graphic: Modesty in the Dictionary: Photograph taken by me 2-9-2014.