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Polyakov A, Piskopos J, Rozen G. Posthumous conception in Australia - legal and ethical considerations. Med Leg J 2024; 92:86-90. [PMID: 37999639 DOI: 10.1177/00258172231200839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Posthumous conception, the ability to conceive a child after the death of one partner, is increasingly prevalent due to advances in Artificial Reproduction Technology (ART). This paper considers the complexities surrounding the practice in Australia, focusing primarily on the ethical and legal dimensions. It observes that state-based regulations in Australia create disparities in accessibility: some states prohibit the procedure without the deceased's written consent, while others permit it based on guidelines or lack explicit prohibitions. Addressing the juxtaposition of Will Theory and Interest Theory, it emphasises the ongoing debate on whether rights, particularly reproductive autonomy, outlive a person's demise. Finally, the paper highlights an evident inconsistency in Australian legislation and promotes a uniform approach across states.
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Affiliation(s)
- Alex Polyakov
- Reproductive Services Unit, The Royal Women's Hospital, Melbourne, Australia; Melbourne IVF, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Jacqueline Piskopos
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Genia Rozen
- Reproductive Services Unit, The Royal Women's Hospital, Melbourne, Australia; Melbourne IVF, Melbourne, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
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Stein A, Altman E, Rotlevi M, Seh D, Wertheimer A, Ben-Haroush A, Shufaro Y. Single men's attitudes towards posthumous use of their sperm cryopreserved due to illness in Israel. Andrology 2024; 12:380-384. [PMID: 37345862 DOI: 10.1111/andr.13483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 03/23/2023] [Accepted: 06/18/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Banking of frozen spermatozoa by single men opens the possibility of procreation long after their death. Requests for posthumous reproduction by the families of the deceased are growing, raising an ethical debate, especially when written instructions were not left by the patients and in cases of unplanned perimortem collection. The issue of the progenitors' intention to procreate after death is the key to ethically based decision-making in these cases. OBJECTIVES To evaluate the attitude of single men cryopreserving spermatozoa before life-threatening medical situations towards post-mortem usage of their cryopreserved spermatozoa. MATERIALS & METHODS Adult single men prior to sperm cryopreservation before cytotoxic therapy were asked to sign a structured form declaring their will and instructions for the usage of their cryopreserved spermatozoa in case of their demise. RESULTS Four hundred fifty-two men of diverse ethnicity, religious and cultural backgrounds signed the form providing instructions for the use of their cryopreserved spermatozoa in case of mortality. Their age was 27.4 ± 8.06 years. Seven (1.5%) patients willed their spermatozoa for posthumous reproduction to a sibling, 22 (4.9%) to parents, and 26 (5.7%) to their informal female partners. The significant majority (n = 397; 87.8 %) of the single men were ordered to destroy their cryopreserved spermatozoa in case of their expiry. Note that, 26-39 years old men were less likely (81.8% vs. >90% in other ages) to order sperm destruction, as well as men with a poorer prognosis (83% vs. 90%). DISCUSSION In this study group, most single men cryopreserving spermatozoa in the face of future life-threatening morbidity do so for their own future live parenthood, and are not interested in posthumous reproduction. CONCLUSION Our results doubt the claim that single men who had an unplanned perimortem sperm collection can be universally presumed to have wished to father a child posthumously. Any claimed assumed consent in these cases should be considered for each case individually based on its specific circumstances.
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Affiliation(s)
- Anat Stein
- Andrology and Sperm Bank, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Altman
- Andrology and Sperm Bank, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach-Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mali Rotlevi
- Andrology and Sperm Bank, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Donia Seh
- Andrology and Sperm Bank, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avital Wertheimer
- Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach-Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Ben-Haroush
- Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach-Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoel Shufaro
- Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Hospital, Petach-Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Barrett F, Sampson A, Campo-Engelstein L, Caplan A, Vadaparampil ST, Quinn GP. Leaving a Legacy: Allied Health Professionals' Perceptions of Fertility Preservation and Posthumous Reproduction for Adolescent and Young Adults with a Poor Cancer Prognosis. J Adolesc Young Adult Oncol 2024; 13:156-161. [PMID: 37294937 PMCID: PMC10877393 DOI: 10.1089/jayao.2022.0184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
Purpose: To explore Allied Health Professionals' (AHPs) experiences with and perceptions of posthumous assisted reproduction (PAR) among adolescent and young adults (AYA, ages 15-39) with a poor cancer prognosis. Methods: We conducted a qualitative analysis of video-based 90-minute focus groups (FGs) of AHPs who participated in the Enriching Communication Skills for Health Professionals in Oncofertility (ECHO) training program from May to August 2021. Moderator-facilitated discussions were guided by topics related to experiences around discussions and utilization of PAR among AYA with a poor cancer prognosis. Thematic analysis was conducted using the constant comparison method. Results: Forty-three AHPs participated in one of seven FGs. Three themes emerged: (1) PAR as palliative care: preserving patient's legacy for their partner, siblings, and parents; (2) ethical and legal considerations for balancing patient's time-sensitive needs; and (3) barriers AHPs encounter navigating complex dynamics of care in this population. Subthemes included an emphasis on patient autonomy, a multidisciplinary approach to counseling, early initiation of fertility discussions continuing over time, documenting reproductive desires, and concerns for family and offspring after patient death. Conclusions: AHPs desired timely conversations on reproductive legacy and family planning. In the absence of institutional policies, training, and resources, AHPs emphasized feeling ill-equipped to navigate the complex dynamics between patients, families, and colleagues. The development of transparent institutional policies, implementation of multidisciplinary care teams, and oversight with ethics committees may improve the provision of reproductive health care and/or end-of-life care for AYA with a poor cancer prognosis and their families.
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Affiliation(s)
- Francesca Barrett
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, New York, USA
| | - Amani Sampson
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, New York, USA
| | - Lisa Campo-Engelstein
- Department of Bioethics & Health Humanities, Institute for Bioethics & Health Humanities, University of Texas Medical Branch, Galveston, Texas, USA
| | - Arthur Caplan
- Division of Medical Ethics, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Susan T. Vadaparampil
- Division of Population Science, Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Gwendolyn P. Quinn
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, New York, USA
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Pollens-Voigt J, Taylor L, Marks A. Ethical and Practical Considerations of Perimortem Gamete Procurement for Palliative Care Providers. J Pain Symptom Manage 2024; 67:e94-e98. [PMID: 37666369 DOI: 10.1016/j.jpainsymman.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/06/2023]
Abstract
Requests for perimortem gamete procurement (PGP) typically arise by a surrogate decision maker after the unexpected death or incapacitation of a reproductive-aged individual. Palliative care clinicians should have a working knowledge of the medical, ethical, and practical considerations pertaining to such requests. In this paper, we describe a case in which the PGP request originated from an incapacitated patient's parents. We review the technologies associated with PGP and posthumous assisted reproduction (PAR) and discuss the ethical and legal issues involved in such cases, including recent position statements from national and international reproductive health groups. Finally, we provider readers with a stepwise approach for considering requests for PGP.
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Affiliation(s)
- Jesse Pollens-Voigt
- Columbia University Vagelos College of Physicians and Surgeons (J.P-V.), New York, New York, USA.
| | - Laura Taylor
- University of Michigan Medical School (L.T., A.M.), Department of Internal Medicine, Division of Geriatrics and Palliative Medicine, Ann Arbor, Michigan, USA
| | - Adam Marks
- University of Michigan Medical School (L.T., A.M.), Department of Internal Medicine, Division of Geriatrics and Palliative Medicine, Ann Arbor, Michigan, USA
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Bokek-Cohen Y, Ravitsky V. Parent-initiated posthumous-assisted reproduction revisited in light of the interest in genetic origins. JOURNAL OF MEDICAL ETHICS 2023; 49:357-360. [PMID: 35725302 DOI: 10.1136/medethics-2022-108204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
A rich literature in bioethics argues against the use of anonymous gamete donation in the name of the 'interest in knowing one's genetic origins'. This interest stems from medical as well as psychosocial and identity reasons. The term 'genealogical bewilderment' has been coined to express the predicament of those deprived of access to information about their origins. Another rich body of literature in bioethics discusses arguments for and against posthumous-assisted reproduction (PAR), with a recent focus on PAR that is initiated by the parents of a deceased man (rather than his partner). This paper revisits arguments against PAR, in light of arguments regarding the interest in knowing one's genetic origins. Limiting the discussion to the specific context of parent-initiated PAR (PIPAR), we argue that the use of cryopreserved sperm from a deceased identifiable man in the context of PIPAR may be ethically preferable when compared with the use of anonymous donor sperm, since it allows genealogical certainty, that is, giving the prospective child access to information about the identity, life story and ancestry of the genetic progenitor as well as genealogical embeddedness, that is, close relationship with extended family members.
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Affiliation(s)
| | - Vardit Ravitsky
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada
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Barrett F, Sutter ME, Campo-Engelstein L, Sampson A, Caplan A, Lawrence M, Vadaparampil ST, Quinn GP. Perspectives surrounding fertility preservation and posthumous reproduction for adolescent and young adults with terminal cancer: Survey of allied health professionals. Cancer Med 2023; 12:6129-6138. [PMID: 36226382 PMCID: PMC10028037 DOI: 10.1002/cam4.5345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND While all reproductive-aged individuals with cancer should be offered fertility preservation (FP) counseling, there is little guidance over offers to adolescent and young adults (AYA) with terminal diagnoses, especially when considering posthumous assisted reproduction (PAR). The Enriching Communication skills for Health professionals in Oncofertility (ECHO/ENRICH) trains Allied Health Professionals (AHPs) to improve communication with AYAs with cancer. Little is known about AHPs' role in assisting in FP and PAR decisions. METHODS This is a cross-sectional survey of ECHO/ENRICH trainees' attitudes and experience with FP and PAR in AYA with terminal cancer. RESULTS The response rate was 61% (365/601). While 69% felt comfortable discussing FP with terminal AYA after ECHO/ENRICH training, 85% desired further education. The majority (88%) agreed FP should be an option for AYA with cancer, though some agreed offering FP provided false hope (16%) or was a waste of resources (7%). Most shared that avoidance of FP discussions was common practice, especially in the medically fragile, late-stage disease, or among minors. Many attributed lack of conversations to oncology team goals. Only 9% had prior experience with PAR. Many were conflicted about how PAR reproductive material should be gifted and who should be permitted to use PAR. Several raised moral concerns for PAR, or discomfort advising family. Many voiced desire for additional PAR-specific education. CONCLUSION ECHO/ENRICH trainees had varied levels of exposure to FP in terminal AYA and limited experiences with PAR. Many expressed uncertainties with PAR, which may be alleviated with further training and transparent institutional policies.
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Affiliation(s)
- Francesca Barrett
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, New York, USA
| | - Megan E Sutter
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, New York, USA
| | - Lisa Campo-Engelstein
- University of Texas Medical Branch, Institute for Bioethics & Health Humanities, Galveston, Texas, USA
| | - Amani Sampson
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, New York, USA
| | - Arthur Caplan
- Division of Medical Ethics, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Morgan Lawrence
- Barnard College, Columbia University, New York, New York, USA
| | - Susan T Vadaparampil
- Division of Population Science, Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Gwendolyn P Quinn
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, New York, USA
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Huang J, Li J, Xiao W, Li Z. Attitudes toward posthumous assisted reproduction in China: a multi-dimensional survey. Reprod Health 2022; 19:122. [PMID: 35598020 PMCID: PMC9124412 DOI: 10.1186/s12978-022-01423-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/06/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Professional legislation and ethics guidelines for posthumous assisted reproduction (PAR) are lacking in China. This study aims to measure the attitudes of the general public, IVF couples, and assisted reproductive technology (ART) practitioners toward PAR in China. METHODS A multi-dimensional survey was designed, and electronic questionnaires were used. General demographic data, reproductive viewpoints, attitudes toward PAR, interactive ability to predict the partner's attitude toward PAR, and the legal attributes and rights to the disposal of posthumous embryos were evaluated. RESULTS The study found that the traditional Chinese viewpoints of fertility had changed. The approval rates for PAR were 79.10%, 55.32%, and 58.89%, in the general public, IVF couples, and ART practitioners, respectively. Most participants agreed that the psychological well-being of offspring should be previously considered before making a PAR decision (81.84%, 73.61%, and 76.98%, respectively). Multivariable logistic regression analysis showed that age, marital status, and gender were common influencing factors, while occupation, religion, and pregnancy history showed no influence on support for PAR. Males and females showed similar predictive abilities for their partners' attitudes toward PAR (57.87% for males, 61.12% for females). Intracouple agreement analysis showed that the consistent rate of consistency in attitudes toward PAR was 65.28%. CONCLUSION The findings suggested that the approval rate of PAR was relatively high in China. Legislation and ethics guidelines for PAR may be considered in China. The psychological well-being of offspring should be considered before the implementation of PAR. Due to the very large regional and demographic differences in China, investigation of a larger samples of participants is necessary.
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Affiliation(s)
- Jiliang Huang
- Reproductive Center of the First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Jinping, Shantou, 515041, Guangdong, People's Republic of China
| | - Jue Li
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, 518110, Guangdong, People's Republic of China
| | - Wanfen Xiao
- Reproductive Center of the First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Jinping, Shantou, 515041, Guangdong, People's Republic of China
| | - Zhiling Li
- Reproductive Center of the First Affiliated Hospital of Shantou University Medical College, No. 57 Changping Road, Jinping, Shantou, 515041, Guangdong, People's Republic of China
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Stuhmcke A. Reflections on autonomy in travel for cross border reproductive care. Monash Bioeth Rev 2021; 39:1-27. [PMID: 33453036 DOI: 10.1007/s40592-020-00125-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2020] [Indexed: 11/27/2022]
Abstract
Travel for reproductive health care has become a widespread global phenomenon. Within the field, the decision to travel to seek third parties to assist with reproduction is widely assumed to be autonomous. However there has been scant research exploring the application of the principle of autonomy to the experience of the cross-border traveller. Seeking to contribute to the growing, but still small, body of sociological bioethics research, this paper maps the application of the ethical principle of autonomy to the lived experience of infertile individuals who cross borders for reproductive care. It examines their choices as patient, consumer and traveller. It suggests that their experience evidences a contradictory autonomy, which offers them both choice and no choice in their final decision to travel. The paper argues that this lack of meaningful autonomy is enabled by a medicalised framework of infertility which prioritises technology as the cure to infertility. This both shapes expectations of infertile individuals and limits their options of family creation. Ultimately, the paper suggests that sociological bioethics research shows that the liberatory credentials of technology should be questioned, and identifies that this field demands greater scholarly attention.
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Affiliation(s)
- Anita Stuhmcke
- Faculty of Law, University of Technology Sydney, Sydney, Australia.
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Trawick E, Sampson A, Goldman K, Campo-Engelstein L, Caplan A, Keefe DL, Quinn GP. Posthumous assisted reproduction policies among a cohort of United States' in vitro fertilization clinics. F S Rep 2020; 1:66-70. [PMID: 34223220 PMCID: PMC8244314 DOI: 10.1016/j.xfre.2020.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To assess the presence and content of policies toward posthumous assisted reproduction (PAR) using oocytes and embryos among Society for Assisted Reproductive Technology (SART) member clinics in the United States. Design Cross-sectional questionnaire-based study. Setting Not applicable. Patient(s) A total of 62 SART member clinics. Intervention(s) Questionnaire including multiple choice and open-ended questions. Main Outcome Measure(s) Descriptive statistics regarding presence and content of policies regarding PAR using oocytes and embryos, consent document content regarding oocyte and embryo disposition, and eligibility of minors and those with terminal illness for fertility preservation. Result(s) Of the 332 clinics contacted, 62 responded (response rate 18.7%). Respondents were distributed across the United States, and average volume of in vitro fertilization (IVF) cycles per year ranged from <250 to >1,500, but 71.2% (n = 42) reported a volume of <500. Nearly one-half (42.4%, n = 25) of clinics surveyed reported participating in any cases of posthumous reproduction during the past 5 years, and 6.8% (n = 4) reported participation in >5 cases. Participation in cases of posthumous reproduction was not significantly associated with practice type or IVF cycle volume among those surveyed. Only 59.6% (n = 34) of clinics surveyed had written policies regarding PAR using oocytes or embryos, whereas 36.8% (n = 21) reported they did not have a policy. Practice type, IVF cycle volume, fertility preservation volume, and prior participation in cases of PAR were not significantly associated with the presence of a policy among respondent clinics. Of those with a policy, 55.9% (n = 19) reported they had used that policy, 59.1% (n = 13) without a policy reported they had considered adopting one, and 63.6% (n = 14) reported they had received a request for PAR services. Only 47.2% (n = 25) of clinics surveyed specified that patients not expected to survive to use oocytes due to terminal illness are eligible for oocyte cryopreservation, whereas 45.3% (n = 24) did not specify. Conclusion(s) Respondent clinics reported receiving an increasing number of requests for PAR services, but many also lacked PAR policies. Those with policies did not always follow ASRM recommendations. Given the low response rate, these data cannot be interpreted as representative of SART clinics overall. As PAR cases become more common, however, this study highlights poor reporting of PAR and institutional policies toward PAR, suggesting that SART clinics may not be equipped to systematically manage the complexities of PAR.
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Affiliation(s)
- Emma Trawick
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amani Sampson
- Department of Obstetrics and Gynecology, Grossman School of Medicine, New York University, New York
| | - Kara Goldman
- Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arthur Caplan
- Division of Medical Ethics, Grossman School of Medicine, New York University, New York
| | - David L Keefe
- Department of Obstetrics and Gynecology, Grossman School of Medicine, New York University, New York
| | - Gwendolyn P Quinn
- Department of Obstetrics and Gynecology, Grossman School of Medicine, New York University, New York
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