Government reviews law on "posthumous conceptions".
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OBJECTIVE: To review our experience with semen retrieval in men who are incompetent or dead and to formulate general medical, legal, and ethical guidelines for practitioners. DESIGN: Case series and literature review. SETTING: Academic. PATIENT(S): Seven incompetent or neurologically dead individuals in whom sperm retrieval was requested. INTERVENTION(S): Electroejaculation. RESULT(S): Seminal emission was induced in the two men who underwent electroejaculation. Sperm suitable for cryopreservation was obtained in one of these men. Review of the legal and ethical implications of such procedures led to development of general guidelines for determining whether gamete retrieval should be performed when requested. Issues of procreational autonomy, consideration of the decedent's wishes, and assurance of the well-being of any new life created were considered most strongly in the formation of these guidelines. CONCLUSION(S): Although the retrieval of sperm from deceased or incompetent individuals may be achieved readily, it is incumbent upon the practitioner to consider the legal and moral implications of these procedures before proceeding.
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The creation of babies by assisted and collaborative techniques of reproduction, such as in-vitro fertilization or cryopreservation of gametes and embryos, stimulates strong emotions and fantasies about life, death, sexuality and immortality. Particularly, the cryopreservation of spermatozoa for post-mortem reproduction forces us to come to terms with the meaning of human reproduction, and the extent of individual rights to procreate using artificial means.
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PURPOSE: We determined the prevalence of requests for postmortem sperm procurement and the degree to which procurement is performed by those working in the field of infertility. MATERIALS AND METHODS: Structured telephone interviews were conducted with personnel at 273 assisted reproductive facilities in the United States and Canada. The number of facilities reporting requests and the number of facilities reporting that they performed the procedure were determined. RESULTS: The prevalence of requests for postmortem sperm procurement was much greater than initially anticipated. A total of 82 requests was reported at 40 facilities in 22 different states between 1980 and 1995. More than half of the reported requests (43) were made between 1994 and 1995. Of the 82 requests 25 were honored at 14 facilities in 11 different states. No requests or procedures were reported from Canada. CONCLUSIONS: Medical advances in postmortem sperm procurement, cryopreservation and in vitro fertilization permit retrieval of sperm after death for various purposes, including posthumous fatherhood. There are no explicit ethical guidelines, legislation or relevant case law, and fertility specialists must confront these issues before proceeding in a field fraught with moral and policy uncertainties.
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Assisted reproduction in general is replete with ethical issues, either revolving around the status of the embryo or the possible conflict between the duty of care to prospective parents, and the responsibility of the carer to the potential offspring; duties to intermediaries in gamete donation are yet another dimension, which may wane in view of the more recent technique of ICSI, a radical transformation in the treatment of male infertility. Specific problems relating to andrology are analysed within the larger context of different ethical theories.