Thinking ethically about genetic inheritance: liberal rights, communitarianism and the right to privacy for parents of donor insemination children

Secondary use of empirical research data in medical ethics papers on gamete donation: forms of use and pitfalls

This paper aims to provide a description of how authors publishing in medical ethics journals have made use of empirical research data in papers on the topic of gamete or embryo donation by means of references to studies conducted by others (secondary use). Rather than making a direct contribution to the theoretical methodological literature about the role empirical research data could play or should play in ethics studies, the focus is on the particular uses of these data and the problems that can be encountered with this use. In the selection of papers examined, apart from being used to describe the context, empirical evidence was mainly used to recount problems that needed solving. Few of the authors looked critically at the quality of the studies they quoted, and several instances were found of empirical data being used poorly or inappropriately. This study provides some initial baseline evidence that shows empirical data, in the form of references to studies, are sometimes being used in inappropriate ways. This suggests that medical ethicists should be more concerned about the quality of the empirical data selected, the appropriateness of the choice for a particular type of data (from a particular type of study) and the correct integration of this evidence in sound argumentation. Given that empirical data can be misused also when merely cited instead of reported, it may be worthwhile to explore good practice requirements for this type of use of empirical data in medical ethics.

Incidental findings of nonparentage: a case for universal nondisclosure

We advocate for the incorporation of a new clause into the consent forms for pediatric genetic testing that clearly states that any incidental information about parentage will not be revealed, regardless of the result. Using a case of misattributed maternity, we examine both the pro- and antidisclosure arguments. In the absence of arguments that clearly demonstrate irrevocable harm from nondisclosure and against a backdrop of arguments that compellingly highlight the potential for serious harms from disclosing incidental findings of nonparentage, we advocate for a universal, institution-wide policy of nondisclosure. Our proposed policy of universal nondisclosure not only provides a viable solution to the disclosure dilemma but also empowers patients to know what testing is available to them and to seek it out on their own terms, fully informed. With an easily implemented consent change, clinics can take a clear and firm stance in the disclosure debate. As a result, patients will be protected, policy will be widely understood, and cases will be resolved consistently and clearly.

The risks of absolute medical confidentiality

Some ethicists argue that patient confidentiality is absolute and thus should never be broken. I examine these arguments that when critically scrutinised, become porous. I will explore the concept of patient confidentiality and argue that although, this is a very important medical and bioethical issue, this needs to be wisely delivered to reduce third party harm or even detriment to the patient. The argument for absolute confidentiality is particularly weak when it comes to genetic information and inherited disease.

Should there be a female age limit on public funding for assisted reproductive technology?

Should there be a female age limit on public funding for assisted reproductive technology (ART)? The question bears significant economic and sociopolitical implications and has been contentious in many countries. We conceptualise the question as one of justice in resource allocation, using three much-debated substantive principles of justice-the capacity to benefit, personal responsibility, and need-to structure and then explore a complex of arguments. Capacity-to-benefit arguments are not decisive: There are no clear cost-effectiveness grounds to restrict funding to those older women who still bear some capacity to benefit from ART. Personal responsibility arguments are challenged by structural determinants of delayed motherhood. Nor are need arguments decisive: They can speak either for or against a female age limit, depending on the conception of need used. We demonstrate how these principles can differ not only in content but also in the relative importance they are accorded by governments. Wide variation in ART public funding policy might be better understood in this light. We conclude with some inter-country comparison. New Zealand and Swedish policies are uncommonly transparent and thus demonstrate particularly well how the arguments we explore have been put into practice.

Technical report: Ethical and policy issues in genetic testing and screening of children

The genetic testing and genetic screening of children are commonplace. Decisions about whether to offer genetic testing and screening should be driven by the best interest of the child. The growing literature on the psychosocial and clinical effects of such testing and screening can help inform best practices. This technical report provides ethical justification and empirical data in support of the proposed policy recommendations regarding such practices in a myriad of settings.

The right to know your genetic parents: from open-identity gamete donation to routine paternity testing

Over the years a number of countries have abolished anonymous gamete donation and shifted toward open-identity policies. Donor-conceived children are said to have a fundamental "right to know" the identity of their donor. In this article, we trace the arguments that underlie this claim and question its implications. We argue that, given the status attributed to the right to know one's gamete donor, it would be discriminatory not to extend this right to naturally conceived children with misattributed paternity. One way to facilitate this would be through routine paternity testing at birth. While this proposal is likely to raise concerns about the conflicting interests and rights of other people involved, we show that similar concerns apply to the context of open-identity gamete donation. Unless one can identify a rational basis for treating the two groups differently, one's stance toward both cases should be the same.

Application of iPS in assisted reproductive technology: sperm from somatic cells?

Infertility is an emotionally charged problem, and it is a condition of increasing incidence. In addition, in 40% to 60% of all infertile couples, it was the male who had a problem that led to infertility. Among the male fertility problems, non-obstructive azoospermia (NOA) (caused by testis failure or impaired spermatogenesis) is the most prevalent. Despite enormous clinical and experimental efforts, treatment of this disorder--assistant reproduction technique (ART) with donor spermatozoa remains controversial. We present the hypothesis that induced pluripotent stem (iPS) cell derived spermatozoa can be a potential source for male gametes for patients with NOA; we support this with the following three evidence: the first is the generation of viable, live-born, fertile mature organism from iPS cells; the second is the successful induced differentiation of male gametes from pluripotent cells in vitro; and the last is the wide use of intracytoplasmic sperm injection (ICSI) in human assisted reproduction. If the hiPS derived spermatozoa prove practical in the generation offspring with ICSI, this method might be able to grant a new chance for NOA patients to have their genetic children with fewer emotional, ethical and legislative problems. To ensure the safety of the technology itself and the production of healthy offspring, further investigations are needed. We also suggest several laboratory and clinical approaches for testing our hypothesis.

To name or not to name? An overview of the social and ethical issues raised by removing anonymity from sperm donors

The aim of this paper is to focus on the ethical issues raised by the removal of anonymity from sperm donors. The increasing currency of a 'right to genetic truth' is clearly visible in the drive to revise the legislation on donor anonymity in Western and European countries. The ethical debate is polarized between the 'right to privacy' of the donor or parent and the 'right to know' of the prospective child. However, it is evident that religious, social and cultural attitudes have an overarching impact on attitudes towards sperm donation generally and anonymity specifically. In Asian countries, the social and cultural heritage is hugely diverse and different from those of the West. This review considers the research exploring the complexity of ethical issues informing this debate, and argues that parent's decisions to reveal donor insemination origins to their children are highly complex and relate to a range of social and cultural attitudes that have not been addressed within the policy to remove anonymity from sperm donors.

Disclosure of donor conception in single-mother families: views and concerns

BACKGROUND

Despite the prevalence of donor conception and the worldwide trend towards openness, there has been little research on whether parents do disclose the nature of the conception to their donor-conceived children. This analysis focuses on whether and how older Israeli single mothers disclose to their children that were conceived using a donor and whether the donor conception causes concern for them.

METHODS

Sixty-two single mothers of donor-conceived children in Israel were asked whether they would like to know the identity of the sperm donor; whether they would like their children to know the identity of the sperm donor when reaching the age of 18, whether they disclosed the circumstances of conception to their children or intend to do so in the future; and whether the sperm donation causes concern to them.

RESULTS

The mothers were divided on whether they wanted to know the identity of the sperm donor. However, less than one-fifth of them did not want their children to have identifying information about the genetic father at the age of 18. About two-thirds of the mothers had not yet disclosed the donor conception to their children but intended to do so in the future. A total of 77.4% of the mothers reported being concerned about the donor conception: for the psychosocial development of the child, fear of genetic disorders, fear of incest and lack of certainty of access to genetic information when needed.

CONCLUSIONS

The tendency to postpone the disclosure reveals the difficulty of these mothers in finding the appropriate way of sharing the information about the conception with their children. Given the importance attached to the age of disclosure and the mothers' concern for the psychosocial development of their children, more professional counselling in this area is warranted.

Attitudes toward oocyte donation among medical and nursing students and couples who have recently become parents: A Swedish study

Aim:  The aim of the present study was to investigate attitudes toward oocyte donation and receiving oocytes in relation to gender, demographic variables and other factors that could influence these attitudes, such as anonymity of the donor and financial compensation. Methods:  The study population consisted of 595 subjects divided into two groups; one group contained men and women who had recently become parents and the other group consisted of medical and nursing students. All subjects were asked to answer a study-specific questionnaire. Results:  The proportions of respondents positive toward oocyte donation were 32% in the student group and 37% in the parental group. Of the respondents in the student group, 87% were positive toward donating organs other than oocytes compared with 78% in the parental group (P < 0.05). In the parental group, the respondents that were positive toward organ donation in general were also more positive toward donating/partner donating and receiving/partner receiving oocytes (P < 0.001 and P < 0.01, respectively). The majority of the respondents stated that their attitudes were not affected by anonymity of the donation, financial compensation or knowing the outcome of the donation. Conclusion:  Respondents' attitudes were unaffected by anonymity of the donation, financial compensation and knowing the outcome of the donation. However, the data suggest that respondents who were positive toward organ donation in general were also more positive toward donating/partner donating and receiving/partner receiving oocytes. (Reprod Med Biol 2008; 7: 161-168).