Mr. P is in a coma, has been declared brain dead, and is on artificial ventilation after an automobile accident. Fiancee, family, and doctors are all agreed that his machines should be unplugged and he allowed to die on his own. However, the fiancee, Ms. M, wants to be artificially inseminated with his sperm and states that the two had been trying to conceive prior to his death. Should Ms. M be allowed to use Mr. P’s sperm? What are the ethical ramifications of using a dead/dying person’s reproductive tissues? How do you define consent in this case?
(Actual Hospital Ethics Committee Case)
Without an advanced directive that clearly states the mans feelings regarding this issue, his sperm cannot be used. Even if the couple was actively working on conceiving a child, there is no way to know how the husband felt about the idea of posthumous conception of his child and the life of his child without a father.
ReplyDeleteI think if you could corroborate her testimony (other friends who know) that his intent was to have a child with her, you could make a reasonable case that she should be allowed to use his sperm. Perhaps a kind of posthumous/virtual consent has to be allowed to account for things like that. Maybe his greatest desire was that she have his sperm- we don't know and we can't rule that out. After all, what young, childless man has an advanced directive? However, there should probably be a mandatory waiting period for her to think about it before being inseminated. She's grieving, and this is a rash decision that she may regret later.
ReplyDeleteOne issue that is not addressed in the prompt is what would be considered satisfactory to the girlfriend regarding the sperm donation. Specifically, at what point and after how many donations would she be satisfied that her wishes were respected? Namely, would it be just one donation, full stop, or enough donations to secure a pregnancy? The hospital board has to be wary of the slippery slope introduced by any permission to obtain a sperm donation. I do believe, however, that this matter should only be considered if the board decides that there is no violation of the dead man's rights on this issue along the lines of the first two comments on this blog.
ReplyDeleteDo dead men have rights?
ReplyDeleteLet the girl have a child with the man for crying out loud especially if that's the last chance he'll ever have to reproduce. Ethics this ethics that... by the time all this red tape is done he won't have any troopers to donate. How about just doing the right thing for a destroyed family without all the BS that goes with it.
ReplyDeleteIn the response to the above comment:
ReplyDeleteThe nice thing isn't always the right thing.
What if the man would hate the idea of her having a child without a father?... or of his body being harvested after his death?
There are a lot of issues here, least of which is "what is the easiest thing to make one person happy?"
In response to Anonymous at 12:01pm timestamp: who cares if he never gets to reproduce? He's dead. If you think about it evolutionarily, he died before he could reproduce--maybe that's natural selection. I just don't accept the contention that he somehow has a right to reproduce or that we should assume he would even want to under these circumstances. Maybe he wanted to reproduce when he was alive but wouldn't want to have her have a fatherless kid.
ReplyDeleteI think the biggest issue here is of consent.
ReplyDeleteImplicit vs. Implied Consent:
In this case, Mr. P did not give a written statement explicitly stating his wishes. Even if you were to look at implied consent, I think the evidence would have to be pretty damn strong to assume consent (ie. more than just his gf saying they were trying to have kids).
No offense to the "just give Ms. M what she wants" stance, but we have rules about these things so that our autonomy/rights can be maintained in the event of our vegetation/death. If I die and my friend told the doctors that I wanted to be ground up as cat food, I'd hope that the doctor would adhere to the established rules and deny that request without proper implicit consent (via living wills etc.).
Strictly speaking, at the point of vegetation/no DPA, Mr. P's medical decisions would then go to next of kin, etc.... however, I'm pretty sure that those decisions can only relate to his own personal medical treatment/disposing of body after death. Superfluous medical procedures (like semen donation) would be considered assault.
As nice as it would be to just give the girlfriend what she wanted, Mr. P's rights must be maintained.
Ground up as cat food? Ummmm, seriously? I mean did I just read that? Wow, lets use an example to defend our argument that is as far away from reasonable as possible. Incredible people, incredible. The lady (HIS lady, HIS Future WIFE!!!) wants nothing more than to have a child with him after the devastation of loosing her husband... ok, so maybe she doesn't quite understand what it is like to raise a child as a single mother, how about maybe giving her a little time to think it over instead of just right away denying her the RIGHT to have a child with her future husband... ok so maybe the unborn child is better off not ever living without a father... how about you ask that child when he/she is 18 "were you not worth having?" and see what he/she answers... and you call that a "superfluous medical procedure"? Wanting to have a "child" with your husband? How about when you decide to have a child with your wife/husband, you tell them "hey hunny how about we perform a superfluous medical procedure i.e. have a baby;" how would that go over with your significant other? Do you have an advanced medical directive at your age? I sure don't. But after reading this post, I may as well go over to MRH and write one that says "if I'm in a vegetative state my wife CAN TAKE MY SEMEN TO HAVE A BABY IF SHE WANTS TO! Because thats what it apparently takes in this red taped/politically correct society. And calling that an assault? Obviously since they have been having sex, the potential for having a child was there, so I guess she was just "assaulting" him every time, although if asked he may have begged differ.
ReplyDeleteAnd yes this is the same anonymous from above... so feel free to add a little more wood to the fire.
Dear Mr. Anonymous,
ReplyDeleteYou obviously have very strong feelings about this issue. Unfortunately, strong emotions and good arguments do not always go hand-in-hand.
First, she is his fiancee, NOT his wife. As such, she has no legal rights to any of his property whatsoever (unless he said so in a will), including his sperm. This is an extremely important distinction and cannot be easily dismissed as "red taped/politically correct". In any specific bioethical situation, you must always consider the precedent you are setting with your decision and the effect it would have if everyone did it. This is not merely about this one woman's desire to have her dead fiance's child. Taken to an extreme, should we just harvest reproductive tissues from everyone who dies? Just in case a girlfriend/boyfriend/whomever wants to use the genetic material some day?
Secondly, two living people trying to conceive is not morally or logically equivalent to one person using a turkey baster with the other person's sperm in order to conceive. If we accept as true that they were trying to conceive prior to his death, it does not then follow that he would desire conception after his death. You can't assume that he would want that just because you do. Some religions, for example, would prohibit this action (e.g. Catholicism). And what about his family? Should they get a say? What if they don't want her to have his baby? The genetic material in the sperm is derived from his parents and grandparents, and so in a way is more theirs than hers.
Finally, I was not aware that being artificially inseminated was a "right". Perhaps this should be added to the Declaration of Independence.
The person who knows him best (his wife) should of course be allowed to make the choice. Forcing everything unforeseeable to be put into an advanced directive is ridiculous and impractical. This is part of the reason some people get married, so that they dont have to deal with the public making decisions for them.
ReplyDeleteNot sure if my opinion will be received since I stumbled upon this and I am a lowly first year without a second of bioethics class. :)
ReplyDeleteThe argument, in my opinion, can be condensed down to who has power of attorney during the end of this man's life and whether power of attorney extends beyond the moment of death.
No way, not even married. Next.
ReplyDeleteThe lawyers have made it a little more complicated than "married or not." As my fiance likes to remind me (in jest), an engagement ring is considered a contractual obligation by law-- the ring being the consideration should either party violate the contract (and take it to court). As the couple was under contract when he died, I believe the fiance does have the right to weigh in on decisions about him and his sperm. I like the idea of a mandatory one-year waiting period before she can put the sperm to use, though, as grief and tragedy has a funny way of making people do things they wouldn't "normally" do.
ReplyDeleteProperty law/marriage:
ReplyDeleteI think we can eliminate case as a property law issue, since a person's body does not fall under property law. If the couple had been married, she would still have not been able to claim his sperm as her property.
Marriage vs. Engagement Rights
Even if the couple actually had been married, I still don't think that it would be ethical to allow the wife to take her husband's sperm posthumously. The issue comes back to consent, which of course is unknown unless specified in a living will. It should be further emphasized that simply being married (or any other contract for that matter) does NOT imply that one spouse owns the body of the other (again, property law does not apply here). For example, even in cases of joint (genetic) custody of a fetus, it is still the woman's body and her right to abort the child if she wishes (Roe v Wade)... nor can a spouse demand sex from the other, and so on. People's bodies are their own, and deserve to be fully protected under the law, regardless of whomever they have wed.
This is why we have living wills.
Wouldn't the man be considered as having diminished autonomy, or he doesn't have full capacity to make the decision for himself. Therefore, would the decision making be handed off to the family members or the future wife?
ReplyDeleteIf it is the family members (because the fiancee is not officially married to the man yet), then their response would probably be based on how they feel about the fiancee.
However, if the decision making is handed over to the fiancee, then she would obviously opt for using Mr.P's sperm, as she states that she and her boyfriend have been trying to conceive.
I do like the idea of collaborating with the fiancee's other friends, to get a confirmation that Ms. M is telling the truth.
I believe that the consent of the patient must have been obtained prior to his death.
ReplyDeleteThink about organ donation: we wouldn't harvest organs from a non-organ donor, likewise I don't think it is legal, or ethical, to harvest any part of a corpse without written consent from the individual.
In my mind it is equivalent to the early anatomists' practice of studying the deceased without their consent.
I am just shooting in the dark here (being I had only one technical ethics class to date) but has anyone considered freezing the sperm first before deciding? The pt's fiance would have no legal rights to it until the physician could make a pertinent decision. While I do believe a physician should be capable of making an ethical decision on his/her own, perhaps consulting a bioethics committee or legal team would be the best option. This obviously is only a temporary solution. A decision must be made. However, this would ensure the physician and family/fiance could consider the matter more closely.
ReplyDeleteI am not trying to suggest a definitive view through this post. What I am asking is would it even be feasible (ethically) to only save the sperm? Would preserving a sample be a violation to the pt's autonomy? Even if eventually the sample was discarded after the doctor decided to deny the fiance's request.
Anonymous, you raise some good points. Certainly a hospital bioethics committee would need to get involved in this case, and actually, probably even the judicial system. However the problem with freezing the sperm before deciding is that in taking the sperm at all you are already making a decision. If one were concerned about violating the dead guy's autonomy-- that is, doing anything that would violate his wishes were he alive--taking his sperm at all might do that anyway.
ReplyDeleteStudentDO2014- excellent points on organ donation. However, in practice, even if someone did not sign explicit documents saying he wanted to donate his organs, if the family agrees that the patient "would have wanted it" or if the family recalls any conversation with the patient about organ donation in which the patient expressed positive feelings toward doing so, the hospital ethics committee can approve of removing the organs anyway. Its a gray area, but the people who knew the patient best have to help decide what he would have wanted (if we accept the premise that his wishes matter now that he is dead/in a permanent vegetative state).
FyfeD: I find the idea of taking a family's word sketchy. Albeit far-fetched, and to what end would be questionable, but the family's so-called recollection could be self-interested. This is why we have written wills, advanced directives, etc.
ReplyDeleteThe idea of freezing the sperm in lieu of a legal/ethical decision seems like the best idea, however it is, if this action is determined to do so, violating the patient's rights/autonomy.
The idea of a gray area in ethics is an interesting topic that takes us off of the ethics topic entirely. Are there truly gray areas to these kinds of issues? Or are there definitely black and white areas that are either unknowable to us or only realizable through excessive gray-area discussions?
StudentDO2014- perhaps it is sketchy to take the family's word, but it is sometimes all we have, and has been the procedure followed in actual cases of this sort. Obviously it is one of several factors--if the physicians or ethics committee don't believe that the family is credible then that would also be a factor, too. Agreed, though, an advanced directive would be preferable, but we live in an imperfect world. This is why we have hospital ethics committees to weight the pros and cons. They have to make a decision based on what information they have, and they do not always have the luxury of knowing their decision is right "beyond a reasonable doubt".
ReplyDeleteGray areas? Of course. Bioethics is riddled with them. This particular issue can be considered gray because it is unclear what the "right" answer is. Perfectly reasonable people have adopted positions on either side of the issue for perfectly valid reasons. Definite "black and white" issues do exist as well...most cultures would agree that murder is wrong, for example. Whether removing sperm from a dead/dying/person in a persistent vegetative state is considered morally permissable depends on the world view of the person you ask.
But why would some issues be clearly black and white and others indeterminate? I understand murder is an extreme case. But what about wars and self-defense? Sure murder is wrong, unless its in a war and unless its in self defense or as a punishment approved by government. When I referenced the vagueness inherent in the rights and wrongs of ethical dilemmas, I was referring to (my personal belief) a sphere of knowledge that will probably never be known by humans, whose attempts at stating knowledge of this sphere generally are nothing more than opinions on what this sphere of knowledge holds.
ReplyDeleteWhen should we label knowledge as unknowable? Some will end their pursuit sooner than others. General relativity was unknowable to humans until Einstein entered the arena. Some minds are more powerful than others, and are thus more capable of knowing. We should limit our pursuit of futile arguments as best we can, but while the fruit of discussing uncertain topics may not be from reaching a conclusion, we often clearly delineate the conditions necessary for a definite answer. I've found that the most interesting discussions stem from gray areas, as obvious cases are boring.
ReplyDeleteA black-and-white issue is one that is obvious, so an unknowable black-and-white issue begs contradiction.
I tend to favor abeyance when conclusions can not be reached, pending further clarification in argument and/or better evidence. In the case above, I could not harvest the sperm with certainty, and while inaction means the woman misses her window of oportunity, she may pave the road for someone else. Little consolation for her, I know, but having a child seems unlikely to augment her grieving process. Other ways of remembering someone's life exist, namely, building a memorial, starting a foundation, etc. The woman seems most interested in continuing her fiance's legacy, not in having a child per se, as she could conceive with someone else. Thus, she would have to prove to me that the child is not simply a vehicle for remembering her loved one.