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Alon I, Cassou M, Golan OC, Ravitsky V. Mapping Ethical, Legal, and Social Implications (ELSI) of gamete donation. J Assist Reprod Genet 2024:10.1007/s10815-024-03229-z. [PMID: 39183224 DOI: 10.1007/s10815-024-03229-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 08/08/2024] [Indexed: 08/27/2024] Open
Abstract
RESEARCH QUESTION This scoping review investigates the Ethical, Legal, and Social Implications (ELSI) of gamete donation, a critical facet of Assisted Reproductive Technologies, by analyzing the evolving research scope, methodological approaches, and the geographical skew in the literature. Despite the increased global uptake of donor gametes, current scholarship predominantly emanates from Western contexts and focuses on majoritized groups. This bias constrains the universality of research findings and limits their applicability across varied legal, cultural, and social contexts, underscoring a need for broader inclusivity. DESIGN We addressed 867 pivotal articles published between 1999 and 2019. RESULTS Our analysis reveals a discernible escalation in research volume, with 62% based on empirical research. The intellectual landscape unfolds into four dominant clusters: Regulatory Frameworks, Incentives, and Access; Family Dynamics and Genetic Linkages; Identity and Privacy in Donor Conception; and Cultural and Societal Attitudes towards GD. Each cluster highlights nuanced dimensions of gamete donation, from regulatory intricacies and psychological welfare to identity ethics and cultural perceptions. CONCLUSION Our findings advocate for a shift towards more globally representative and methodologically inclusive research. By integrating diverse cultural narratives and expanding geographical breadth, future research can offer holistic understandings of gamete donation, fostering equitable and culturally resonant practices and policies worldwide.
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Affiliation(s)
- Ido Alon
- Department of Development Economics, Autonomous University of Madrid, Madrid, Spain.
- University of Montreal, Montreal, Canada.
| | | | - Orit Cherny Golan
- University of Montreal, Montreal, Canada
- Yezreel Valley College, Yezreel Valley, Israel
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Farsides B, Lucassen AM. Ethical preparedness and developments in genomic healthcare. JOURNAL OF MEDICAL ETHICS 2023:jme-2022-108528. [PMID: 37268409 DOI: 10.1136/jme-2022-108528] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 05/17/2023] [Indexed: 06/04/2023]
Abstract
Considerations of the notion of preparedness have come to the fore in the recent pandemic, highlighting a need to be better prepared to deal with sudden, unexpected and unwanted events. However, the concept of preparedness is also important in relation to planned for and desired interventions resulting from healthcare innovations. We describe ethical preparedness as a necessary component for the successful delivery of novel healthcare innovations, and use recent advances in genomic healthcare as an example. We suggest that practitioners and organisations charged with delivering innovative and ambitious healthcare programmes can only succeed if they are able to exhibit the attribute of ethical preparedness.
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Affiliation(s)
- Bobbie Farsides
- Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - Anneke M Lucassen
- Clinical Ethics, Law and Society (CELS), Centre for Personalised Medicine, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
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Horton R, Lucassen A. Ethical Considerations in Research with Genomic Data. New Bioeth 2023; 29:37-51. [PMID: 35484929 DOI: 10.1080/20502877.2022.2060590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Our ability to generate genomic data is currently well ahead of our ability to understand what they mean, raising challenges about how best to engage with them. This article considers ethical aspects of work with such data, focussing on research contexts that are intertwined with clinical care. We discuss the identifying nature of genomic data, the medical information intrinsic within them, and their linking of people within a biological family. We go on to consider what this means for consent, the importance of thoughtful sharing of genomic data, the challenge of constructing meaningful findings, and the legacy of unequal representation in genomic datasets. We argue that the ongoing success of genomic data research relies on public trust in the enterprise: to justify this trust, we need to ensure robust stewarding, and wide engagement about the ethical issues inherent in such practices.
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Affiliation(s)
- Rachel Horton
- Centre for Personalised Medicine, St Anne's College, University of Oxford, Oxford, UK.,Clinical Ethics, Law and Society, University of Southampton, Southampton, UK
| | - Anneke Lucassen
- Centre for Personalised Medicine, St Anne's College, University of Oxford, Oxford, UK.,Clinical Ethics, Law and Society, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
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Pinto da Silva S, de Freitas C, Silva S. Medical ethics when moving towards non-anonymous gamete donation: the views of donors and recipients. JOURNAL OF MEDICAL ETHICS 2022; 48:616-623. [PMID: 34172523 DOI: 10.1136/medethics-2020-106947] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 04/15/2021] [Accepted: 05/04/2021] [Indexed: 06/13/2023]
Abstract
Drawing on the views of donors and recipients about anonymity in a country that is experiencing a transition towards non-anonymous gamete donation mandated by the Constitutional Court, we explore how the intersection between rights-based approaches and an empirical framework enhances recommendations for ethical policy and healthcare. Between July 2017 and April 2018, 69 donors and 147 recipients, recruited at the Portuguese Public Bank of Gametes, participated in this cross-sectional study. Position towards anonymity was assessed through an open-ended question in a self-report questionnaire, which was subject to content analysis. Preference for an anonymous donation regime was mentioned by 82.6% of donors and 89.8% of recipients; and all those with children. Instead of the rights-based reasoning used by the Constitutional Court, donors highlighted concerns over future relationships and recipients focused on socioethical values linked with the safeguard of safety, privacy and confidentiality. The remaining participants advocated the choice between anonymity or non-anonymity (double-track policy), invoking respect for their autonomy. The complex, diverse ethical views and reasoning of donors and recipients expand a traditionally dichotomous discussion. Their perspectives challenge the transition towards non-anonymity and international guidelines, raising awareness to the need for their involvement in the design of policies to enable choice according to their values and preferences, and of psychosocial counselling responsive to their socioethical concerns and sensitive to their parental status. Empirical frameworks complement rights-based approaches to uphold justice, fairness and equal respect, and to incorporate utility, beneficence and non-maleficence in policymaking and healthcare in the transition towards non-anonymity.
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Affiliation(s)
- Sandra Pinto da Silva
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Cláudia de Freitas
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Susana Silva
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Weller S, Lyle K, Lucassen A. Re-imagining ‘the patient’: Linked lives and lessons from genomic medicine. Soc Sci Med 2022; 297:114806. [PMID: 35219975 PMCID: PMC8943276 DOI: 10.1016/j.socscimed.2022.114806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 11/17/2022]
Abstract
How ‘the patient’ is imagined has implications for ethical decision-making in clinical practice. Patients are predominantly conceived in an individualised manner as autonomous and independent decision-makers. Fields such as genomic medicine highlight the inadequacies of this conceptualisation as patients are likely to have family members who may be directly affected by the outcome of tests in others. Indeed, professional guidance has increasingly taken a view that genetic information should, at times, be regarded as of relevance to families, rather than individuals. What remains absent from discussions is an understanding of how those living through/with genomic testing articulate, construct, and represent patienthood, and what such understandings might mean for practice, particularly ethical decision-making. Employing the notion of ‘linked lives’ from lifecourse theory, this article presents findings from a UK-based qualitative longitudinal study following the experiences of those affected by the process and outcomes of genomic testing. The article argues that there is a discord between lived experiences and individualised notions of ‘the patient’ common in conventional bioethics, with participants predominantly locating their own decision-making within the matrix of linked lives in which they are embedded. In the quest to gain ‘answers’, many took an intra or intergenerational view, connecting their own experiences to those of past generations through familial narratives around probable explanations, and/or hopes and expectations for the health of imagined future generations. The article argues that a re-imagining of ‘the patient’, that reflects the complex and shifting nature of patienthood, will be imperative as genomic medicine is mainstreamed. How ‘the patient’ is imagined has implications for ethical decision-making. Genomic medicine shows the shortcomings of individualised notions of ‘the patient’. Instead, a ‘linked lives’ lens highlights the ensembles of relationships affected. Participants reported more collective inter/intra-generational views of patienthood. Re-imagining patienthood beyond the individual is vital as genomics is mainstreamed.
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Affiliation(s)
- Susie Weller
- Clinical Ethics, Law and Society (CELS); Wellcome Centre for Human Genetics, University of Oxford, UK; Clinical Ethics, Law and Society (CELS) - Southampton, Faculty of Medicine, University of Southampton, UK.
| | - Kate Lyle
- Clinical Ethics, Law and Society (CELS); Wellcome Centre for Human Genetics, University of Oxford, UK; Clinical Ethics, Law and Society (CELS) - Southampton, Faculty of Medicine, University of Southampton, UK
| | - Anneke Lucassen
- Clinical Ethics, Law and Society (CELS); Wellcome Centre for Human Genetics, University of Oxford, UK; Clinical Ethics, Law and Society (CELS) - Southampton, Faculty of Medicine, University of Southampton, UK
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Riaño-Galán I, Martínez González C, Gallego Riestra S. Ethical and legal questions of anonymity and confidentiality in gamete donation. An Pediatr (Barc) 2021. [DOI: 10.1016/j.anpede.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Riaño-Galán I, Martínez González C, Gallego Riestra S. [Ethical and legal questions of anonymity and confidentiality in gamete donation]. An Pediatr (Barc) 2021; 94:337.e1-337.e6. [PMID: 33712405 DOI: 10.1016/j.anpedi.2021.02.008] [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: 01/15/2021] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 11/19/2022] Open
Abstract
Spain is the European country where more assisted reproduction techniques (ART) are performed, reaching 9% of newborns. The objective of this article is to introduce the legal framework and to analyze some ethical questions, not without controversy, in relation to the anonymity of gamete donors and the concealment of origin by ART from their children. Spanish legislation establishes the relative anonymity of donors: both gamete recipients and born children have the right to obtain general information about them as long as their identity is not included, but in situations of risk to the life and health of the children allows your bankruptcy. Likewise, an unequivocal right to privacy and confidentiality of submission to the ART is established. The movement aimed at introducing in our country a legislative amendment that ends the anonymity of gamete donors is based on the right of those children to know their biological origin. Along with legal changes, the attitude of parents and professionals must gradually change towards more transparent and responsible communication, based on the experiences of adults conceived by these techniques, and those adopted. Building values such as trust and truth in the family relationships from responsibility requires placing the children, largely forgotten and the most vulnerable part, at the center of the debate.
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Affiliation(s)
- Isolina Riaño-Galán
- AGC Pediatría, Hospital Universitario Central de Asturias (HUCA). IUOPA-Departamento de Medicina-ISPA, Universidad de Oviedo. CIBERESP, Oviedo, España.
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Horton R, Fenwick A, Lucassen AM. Old consent and new developments: health professionals should ask and not presume. JOURNAL OF MEDICAL ETHICS 2020; 46:412-413. [PMID: 31662484 PMCID: PMC7610401 DOI: 10.1136/medethics-2019-105868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Rachel Horton
- Clinical Ethics and Law group (CELS), Faculty of Medicine, University of Southampton, Southampton, UK
| | - Angela Fenwick
- Clinical Ethics and Law group (CELS), Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anneke M Lucassen
- Clinical Ethics and Law group (CELS), Faculty of Medicine, University of Southampton, Southampton, UK
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Frith L. Contacting gamete donors to facilitate diagnostic genetic testing for the donor-conceived child: what are the rights and obligations of gamete donors in these cases? A response to Horton et al. JOURNAL OF MEDICAL ETHICS 2020; 46:220-222. [PMID: 31481473 DOI: 10.1136/medethics-2019-105629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/02/2019] [Accepted: 08/15/2019] [Indexed: 06/10/2023]
Abstract
In their paper Horton et al argue that it is acceptable to contact an anonymous egg-donor to facilitate diagnostic genetic testing for the donor conceived child, despite the donor, 'indicating on a historical consent form that she did not wish to take part in future research, and that she did not wish to be informed if she was found to be a carrier of a "harmful inherited condition"'. There are a number of claims embedded in Horton et al's position that it is acceptable to contact the donor and request that she at least think about participating in genetic testing. In this response. I will go through their main claims and argue that the area of genomic medicine does not justify exceptions to general consent conditions as the authors suppose and conclude that the donor should not be contacted. I will then go on to suggest a policy change that would address Horton et al's concerns but would not involve over-riding any previously expressed wishes.
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Affiliation(s)
- Lucy Frith
- Institute of Population Health, University of Liverpool, Liverpool L69 3BX, UK
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Exploring broad consent in the context of the 100,000 Genomes Project: a mixed methods study. Eur J Hum Genet 2020; 28:732-741. [PMID: 31919452 DOI: 10.1038/s41431-019-0570-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/06/2019] [Accepted: 12/17/2019] [Indexed: 11/09/2022] Open
Abstract
The 100,000 Genomes Project (100kGP)-a hybrid clinical-research initiative-was set up to analyse whole-genome sequences (WGS) from patients living with a rare disease or cancer. The project positioned participant consent as being of central importance, but consent in the context of genomic testing raises challenging issues. In this mixed method study, we surveyed 1337 100kGP participants regarding their experiences of taking part in the project and conducted in-depth interviews with 24 survey respondents to explore these findings further. Survey responses were analysed using descriptive statistics and interview data were analysed thematically. The consent approach of the 100kGP resulted in a proportion of our study's participants not understanding the complexities of the project and what types of results they might receive; for example, 20% of participants who we surveyed from the cancer arm did not recall what decisions they had made regarding additional findings. It is not surprising that a project such as this, with such diverse aims and participant groups, would throw up at least some challenges. However, participants reported being satisfied with their experience of the project to date. Our study highlights that in the context of consent for more complex endeavours, such as the 100kGP, it is important to assess (and document) an agreement to take part, but complicated decisions about what and when to communicate may need revisiting over time in response to changing contexts. We discuss the implications of our findings with reference to participants of the 100kGP and the newly formed NHS Genomic Medicine Service.
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McMillan J. Clinical ethics and the duty of care. JOURNAL OF MEDICAL ETHICS 2019; 45:355-356. [PMID: 31217226 DOI: 10.1136/medethics-2019-105613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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