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Bywall KS, Drevin J, Groothuis-Oudshoorn C, Veldwijk J, Nyholm D, Widner H, van Vliet T, Jiltsova E, Hansson M, Johansson JV. Patients accept therapy using embryonic stem cells for Parkinson's disease: a discrete choice experiment. BMC Med Ethics 2023; 24:83. [PMID: 37828462 PMCID: PMC10571417 DOI: 10.1186/s12910-023-00966-1] [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] [Received: 03/17/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND New disease-modifying ways to treat Parkinson's disease (PD) may soon become a reality with intracerebral transplantation of cell products produced from human embryonic stem cells (hESCs). The aim of this study was to assess what factors influence preferences of patients with PD regarding stem-cell based therapies to treat PD in the future. METHODS Patients with PD were invited to complete a web-based discrete choice experiment to assess the importance of the following attributes: (i) type of treatment, (ii) aim of treatment, (iii) available knowledge of the different types of treatments, (iv) effect on symptoms, and (v) risk for severe side effects. Latent class conditional logistic regression models were used to determine preference estimates and heterogeneity in respondents' preferences. RESULTS A substantial difference in respondents' preferences was observed in three latent preference patterns (classes). "Effect on symptoms" was the most important attribute in class 1, closely followed by "type of treatment," with medications as preferred to other treatment alternatives. Effect on symptoms was also the most important attribute in class 2, with treatment with hESCs preferred over other treatment alternatives. Likewise for class 3, that mainly focused on "type of treatment" in the decision-making. Respondents' class membership was influenced by their experience in treatment, side effects, and advanced treatment therapy as well as religious beliefs. CONCLUSIONS Most of the respondents would accept a treatment with products emanating from hESCs, regardless of views on the moral status of embryos. Preferences of patients with PD may provide guidance in clinical decision-making regarding treatments deriving from stem cells.
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Affiliation(s)
- Karin Schölin Bywall
- School of Health, Care and Social Welfare, Division of Health and Welfare Technology, Mälardalen University, Västerås, Sweden.
- Centre for Research Ethics and Bioethics, Uppsala University, Box 564, Uppsala, SE-751 22, Sweden.
| | - Jennifer Drevin
- Centre for Research Ethics and Bioethics, Uppsala University, Box 564, Uppsala, SE-751 22, Sweden
| | - Catharina Groothuis-Oudshoorn
- Health Technology and Services Research (HTSR), Faculty of Behavioural Management and Social Sciences, University of Twente, Enschede, The Netherlands
| | - Jorien Veldwijk
- Centre for Research Ethics and Bioethics, Uppsala University, Box 564, Uppsala, SE-751 22, Sweden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Dag Nyholm
- Department of Medical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, SE-751 85, Sweden
| | - Hakan Widner
- Department of Neurology, Skåne University Hospital, Lund, SE-221 85, Sweden
| | - Trinette van Vliet
- Department of Neurology, Skåne University Hospital, Lund, SE-221 85, Sweden
| | - Elena Jiltsova
- Department of Medical Sciences, Uppsala University, Uppsala University Hospital, Uppsala, SE-751 85, Sweden
| | - Mats Hansson
- Centre for Research Ethics and Bioethics, Uppsala University, Box 564, Uppsala, SE-751 22, Sweden
| | - Jennifer Viberg Johansson
- Centre for Research Ethics and Bioethics, Uppsala University, Box 564, Uppsala, SE-751 22, Sweden
- The Institute for Future Studies, Holländargatan 13, 111 36, Stockholm, Sweden
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Attitudes and values among the Swedish general public to using human embryonic stem cells for medical treatment. BMC Med Ethics 2022; 23:138. [PMID: 36550460 PMCID: PMC9773498 DOI: 10.1186/s12910-022-00878-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The use of human embryonic stem cells (ES cells) for the development of medical therapies is surrounded with moral concerns. The aim of this study was to assess the public's attitudes toward the use of ES cells for treatment of Parkinson's disease (PD) and other diseases, what factors are most important to consider when using ES cells for drug development, and if there is an association between religious beliefs and attitudes toward using ES cells for medical treatment. METHODS A randomly selected sample of the Swedish public, aged 18-87-years-old, completed an online survey (n = 467). The survey assessed socio-demographics, religious views, perceived moral status of the embryo, and attitudes toward using ES cells for medical treatment of PD and other diseases. Adjusted odds ratios (ORs) and 95% confidence intervals (CI) for positive vs. negative attitude toward using ES cells for drug development were computed using logistic regression. RESULTS The respondents were positive about using ES for treatment; specifically, 70% totally agreed that it is acceptable to use ES cells for treatment of PD, while 40% totally agreed that it is acceptable to use ES cells for treatment but induced pluripotent cells is just as efficient. Religion being of little importance in one's life was associated with a positive attitude toward using ES cells for treatment of PD (adjusted OR 6.39, 95% CI 2.78-14.71). The importance of being able "to access new, effective treatments against diseases that do not have any treatment available" was ranked as the most important factor to consider when using ES cells for drug development. CONCLUSION Most respondents are positive about using ES cells for drug development, and making effective treatments accessible to those who do not have any. However, these attitudes are influenced by the specific disorder that the drug development is intended for, as well as the religious views and perceived moral status of the early embryo.
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Eichenberg C, Huss J, Küsel C, Hertlein K. Desire to Have Children and the Internet: Aspects for Psychosomatic Practice. JOURNAL OF COUPLE & RELATIONSHIP THERAPY 2022. [DOI: 10.1080/15332691.2022.2136810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Christiane Eichenberg
- Medical Faculty, Institute of Psychosomatics, Sigmund Freud University, Vienna, Austria
| | - Jessica Huss
- Department of Psychology, University of Kassel, Kassel, Germany
| | - Cornelia Küsel
- Computer Science Department, Universität der Bundeswehr München, Munich, Germany
| | - Katherine Hertlein
- Department of Psychiatry and Behavioral Health, Kirk Kerkorian School of Medicine, University of Las Vegas, Las Vegas, Nevada, USA
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Grauman Å, Drevin J. Perceptions on using surplus embryos for the treatment of Parkinson's disease among the Swedish population: a qualitative study. BMC Med Ethics 2022; 23:15. [PMID: 35246133 PMCID: PMC8895863 DOI: 10.1186/s12910-022-00759-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human embryonic stem cells are currently used for developing treatment against Parkinson's disease (PD). However, the use of ES cells is surrounded with moral concerns. Research regarding the public's attitudes can form an important basis for policymaking. The aim was to explore the perceptions of the public on using donated human embryos for developing treatment of Parkinson's Disease. METHODS Semi-structured individual qualitative interviews were conducted with 11 members of the general population in Sweden. Interviews were analyzed with thematic content analyses. RESULTS Four categories and additional sub-categories; Different views on the embryo requires delicacy, Using embryos to treat Parkinson's disease, Doing things in the right way, and Communication, media, and public opinion. In general, respondents were positive towards the usage of embryotic stem cells to treat PD, but the usage were conditioned and specific terms were demanded. Informed consent from both donors were required and delicacy and sensitivity when working with embryos were needed. CONCLUSIONS It was perceived better to use surplus embryos to treat PD increase is than to discard them, also among those who perceived the embryo as "a potential life." The participants raised several conditions under usage for treatment should be allowed. Even if the embryos otherwise are going to be discarded, usage requires informed consent from the donating couples.
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Affiliation(s)
- Åsa Grauman
- Centre for Research Ethics and Bioethics, Uppsala University, Box 564, 751 22, Uppsala, Sweden.
| | - Jennifer Drevin
- Centre for Research Ethics and Bioethics, Uppsala University, Box 564, 751 22, Uppsala, Sweden
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Álvarez-Díaz JA. Embryo donation among Latin-Americans who have attended assisted reproduction techniques: a first empirical approach. JBRA Assist Reprod 2021; 25:81-89. [PMID: 32870624 PMCID: PMC7863107 DOI: 10.5935/1518-0557.20200055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/30/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To determine whether Latin Americans who have undergone assisted reproduction techniques would donate embryos. METHODS This is a multinational cross-sectional study, involving 602 patients. We invited the Latin American Network of Assisted Reproduction centers. Those who accepted received the instrument distributed among the patients who agreed by signing the informed consent form. In total, 261 men and 341 women participated from seven countries. RESULTS Patients would donate their embryos as follows: treatment with embryonic stem cells (73.6%), heterosexual couples (63.8%), Assisted Reproduction Techniques (ART) research (57%), scientific or basic research (55.3%), research with embryonic stem cells (55.2%), premenopausal women (53.8%), single women (45.1%), people with disabilities (25.4%), lesbians (25.3%), menopausal women (25.2%), lesbian couples (24.6%), gay couples (19.6%), senile women (15.1%). CONCLUSIONS The results favor embryos donation for research purposes, and a little less for clinical purposes, contrary to what was thought in qualitative studies conducted among Latin American populations.
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Armuand G, Skoog Svanberg A, Lampic C, Elenis E, Sydsjö G. Attitudes among paediatric healthcare professionals in Sweden towards sperm donation to single women: a survey study. FERTILITY RESEARCH AND PRACTICE 2020; 6:9. [PMID: 32391162 PMCID: PMC7203798 DOI: 10.1186/s40738-020-00078-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 04/24/2020] [Indexed: 11/10/2022]
Abstract
Background The number of families conceived through sperm donation to single women is increasing. However, there is limited knowledge about health care professionals’ attitudes towards solo-mothers by choice, and there is some indication that professionals’ personal opinions influence their care of individuals who use alternate ways to build a family. The primary aim of the study was to investigate attitudes towards, and experiences of, families following sperm donation to single women among healthcare professionals working in primary child healthcare. Methods Between April and November 2016 a total of 712 physicians, registered nurses and psychologists working within primary healthcare in Sweden were invited to participate in a cross-sectional online survey study. The study-specific questionnaire contained the following four domains: Attitudes towards legalization and financing, Attitudes towards the family and the child’s health, Clinical experience and Knowledge about sperm donation to single women. Results The majority of the participants were positive or neutral towards sperm donation being allowed to single women in Sweden. However, one third believed that children risk worse mental health and social stigma. Half of healthcare professionals had own clinical experience of caring for solo-mothers by choice and their children, and of these one third perceived that these families had more need of support than other parents. One out of four indicated that they did not have sufficient knowledge to be able to provide adequate care to these families. Conclusions The present results indicate that while there was a relatively large support for sperm donation being allowed to single women in Sweden among health care professionals, many expressed concerns about the child’s health, as well as low confidence in their knowledge about the specific needs in this patient group. There is a need for educational interventions targeted to healthcare professionals in primary child healthcare in order to provide adequate care to solo-mothers by choice and their children.
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Affiliation(s)
- Gabriela Armuand
- 1Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Agneta Skoog Svanberg
- 2Department of Women's and Children's Health, Uppsala University, 751 85 Uppsala, Sweden
| | - Claudia Lampic
- 3Department of Women's and Children's Health, Karolinska Institutet, 171 77 Stockholm, Sweden.,4Department of Public Health and Caring Sciences, Uppsala University, 751 22 Uppsala, Sweden
| | - Evangelia Elenis
- 2Department of Women's and Children's Health, Uppsala University, 751 85 Uppsala, Sweden
| | - Gunilla Sydsjö
- 1Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, SE-581 83 Linköping, Sweden.,5Department of Gynecology and Obstetrics in Linköping, County Council of Östergötland, 581 83 Linköping, Sweden
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Armuand G, Sydsjö G, Skoog Svanberg A, Lampic C. Attitudes towards embryo donation among healthcare professionals working in child healthcare: a survey study. BMC Pediatr 2019; 19:209. [PMID: 31238888 PMCID: PMC6591860 DOI: 10.1186/s12887-019-1578-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 06/06/2019] [Indexed: 01/15/2023] Open
Abstract
Background The aim of this study was to investigate attitudes towards embryo donation and embryo donation families among professionals working in primary child healthcare, and their experiences of these families. Methods A cross-sectional online survey was conducted in Sweden between April and November 2016. A total of 712 primary healthcare physicians, registered nurses and psychologists were approached to participate in this study. The study-specific questionnaire measured attitudes and experiences in the following four domains: legalisation and financing, the family and the child’s health, clinical experience of meeting families following embryo donation, and knowledge of embryo donation. Results Of the 189 women and 18 men who completed the questionnaire (response rate 29%), relatively few (13%) had clinical experience of caring for families following embryo donation. Overall, 69% supported legalisation of embryo donation for infertile couples, and 54% agreed it should be publicly funded. The majority (88%) agreed the child should have the right to know the donors’ identity. Respondents did not believe that children conceived through embryo donation are as healthy as other children (50%), citing the risks of poor mental health (17%) and social stigmatization (18%). Approximately half reported low confidence in their own knowledge of embryo donation (47%) and wanted to know more (58%). Conclusions These results indicate relatively large support among healthcare professionals in Sweden for the legalisation of embryo donation. In order to provide adequate healthcare to families following embryo donation, there is a need to develop educational resources to increase knowledge about the medical and psychosocial consequences of embryo donation among healthcare professionals working in primary healthcare.
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Affiliation(s)
- Gabriela Armuand
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, SE-581 83, Linköping, Sweden.
| | - Gunilla Sydsjö
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, SE-581 83, Linköping, Sweden.,Department of Gynaecology and Obstetrics in Linköping, County Council of Östergötland, Linköping, Sweden
| | - Agneta Skoog Svanberg
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-751 85, Uppsala, Sweden
| | - Claudia Lampic
- Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18A, SE-171 77, Stockholm, Sweden
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Stenfelt C, Armuand G, Wånggren K, Skoog Svanberg A, Sydsjö G. Attitudes toward surrogacy among doctors working in reproductive medicine and obstetric care in Sweden. Acta Obstet Gynecol Scand 2018. [PMID: 29512820 DOI: 10.1111/aogs.13342] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of this study was to investigate attitudes and opinions towards surrogacy among physicians working within obstetrics and reproductive medicine in Sweden. MATERIAL AND METHODS Physicians working within medically assisted reproduction (MAR), antenatal care and obstetrics were invited to participate in a cross-sectional nationwide survey study. The study-specific questionnaire measured attitudes and experiences in three domains: attitudes towards surrogacy, assessment of prospective surrogate mothers, and antenatal and obstetric care for surrogate mothers. RESULTS Of the 103 physicians who participated (response rate 74%), 63% were positive or neutral towards altruistic surrogacy being introduced in Sweden. However, only 28% thought that it should be publicly financed. Physicians working at fertility clinics were more positive towards legalization as well as public financing of surrogacy compared than were those working within antenatal and delivery care. The majority of the physicians agreed that surrogacy involves the risk of exploitation of women's bodies (60%) and that there is a risk that the commissioning couple might pay the surrogate mother "under the table" (82%). They also expressed concerns about potential surrogate mothers not being able to understand fully the risks of entering pregnancy on behalf of someone else. CONCLUSION There is a relatively strong support among physicians working within obstetrics and reproductive medicine for the introduction of surrogacy in Sweden. However, the physicians expressed concerns about the surrogate mothers' health as well as the risk of coercion. Further discussions about legalization of surrogacy should include views from individuals within a wide field of different medical professions and laymen.
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Affiliation(s)
- Camilla Stenfelt
- Fertilitetscentrum Stockholm, Stockholm, Sweden.,Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Gabriela Armuand
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Kjell Wånggren
- Department of Clinical Science Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Agneta Skoog Svanberg
- Department of Women's and Children's Health, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Gunilla Sydsjö
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.,Department of Gynecology and Obstetrics in Linköping, County Council of Östergötland, Linköping, Sweden
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Armuand G, Lampic C, Skoog-Svanberg A, Wånggren K, Sydsjö G. Survey shows that Swedish healthcare professionals have a positive attitude towards surrogacy but the health of the child is a concern. Acta Paediatr 2018; 107:101-109. [PMID: 28840628 DOI: 10.1111/apa.14041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/26/2017] [Accepted: 08/08/2017] [Indexed: 12/22/2022]
Abstract
AIM In February 2016, Sweden upheld its ban on surrogacy following a Government enquiry. This survey investigated attitudes towards surrogacy among primary health professionals working with children and their experiences of working with families following surrogacy abroad. METHODS From April to November 2016, nurses, physicians and psychologist working in primary child health care in four counties in Sweden were invited to participate in a cross-sectional online survey about surrogacy. RESULTS The mean age of the 208 participants was 49.2 years (range 27-68) and nearly 91% were women. Approximately 60% supported legalised surrogacy. Wanting a conscience clause to be introduced in Sweden was associated with not supporting surrogacy for any groups, while personal experiences of infertility and clinical experiences with families following surrogacy were associated with positive attitudes towards surrogacy for heterosexual couples. The majority (64%) disagreed that surrogate children were as healthy as other children, and many believed that they risked worse mental health (21%) and social stigmatisation (21%). CONCLUSION We found that 60% supported legalised surrogacy, but many expressed concerns about the children's health and greater knowledge about the medical and psychosocial consequences of surrogacy is needed.
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Affiliation(s)
- G Armuand
- Department of Clinical and Experimental Medicine; Faculty of Health Sciences; Linköping University; Linköping Sweden
| | - C Lampic
- Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Huddinge Sweden
| | - A Skoog-Svanberg
- Department of Women's and Children's Health; Uppsala University Uppsala; Uppsala Sweden
| | - K Wånggren
- Department of Clinical Science Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - G Sydsjö
- Department of Clinical and Experimental Medicine; Faculty of Health Sciences; Linköping University; Linköping Sweden
- Department of Gynecology and Obstetrics in Linköping; County Council of Östergötland; Linköping Sweden
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Raz A, Amer-Alshiek J, Goren-Margalit M, Jacobi G, Hochberg A, Amit A, Azem F, Amir H. Donation of surplus frozen pre-embryos to research in Israel: underlying motivations. Isr J Health Policy Res 2016; 5:25. [PMID: 27822357 PMCID: PMC5097401 DOI: 10.1186/s13584-016-0085-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 06/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background The high number of IVF procedures performed in Israel has had an unforeseen consequence: accumulation of large amounts of surplus frozen embryos. After five years that the frozen embryos are kept for free, patients need to make an embryo disposition decision. One option is donation for research. The donation rate in Israel is very low. Our aim was to understand the attitudes, values and perceptions of female IVF patients that decided to donate their surplus frozen embryos to research. Methods The study setting was a tertiary IVF unit which during the 2000–2009 period treated 241 patients who had their frozen pre-embryos stored for more than five years. The study population consists of the 12 patients (from among the 241) who had decided to donate their excess frozen pre-embryos to research. In-depth interviews were carried out with 8 of those 12 patients. Results IVF patients who donated their surplus frozen pre-embryos to research viewed the frozen embryo as a valuable resource that does not have human identity yet. The majority expressed a gradualist approach to the human status of the embryo as requiring successful implantation and development in the uterus. All the respondents chose donation to research not because it was their first choice but because they did not want or were unable to use the pre-embryos in the future, in addition to not willing to thaw them. For many of the respondents, donation to research was accompanied by a sense of uncertainty. All would have preferred to donate their pre-embryos to infertile women or couples, an option which is currently prohibited in Israel. Conclusions The moral reasoning behind decisions that patients make regarding excess pre-embryos is important for health care practitioners to consider when offering decision-making alternatives and counseling. For our respondents, the scarcity of donating excess frozen pre-embryos to research may reflect patients' preference for embryo donation to infertile couples. Recommended ways to increase donation to research may include public education and awareness, as well as targeted communication with IVF patients by multi-professional IVF unit teams comprised of a medical doctor and a professional trained in bioethics.
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Affiliation(s)
- Aviad Raz
- Department of Sociology and Anthropology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Jonia Amer-Alshiek
- Sarah Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, Israel
| | - Mor Goren-Margalit
- Department of Sociology and Anthropology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gal Jacobi
- Department of Sociology and Anthropology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alyssa Hochberg
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | - Ami Amit
- Sarah Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, Israel
| | - Foad Azem
- Sarah Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, Israel
| | - Hadar Amir
- Sarah Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, Israel
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