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Piek SR, Martani A, Pennings G. Against age limits for men in reproductive care. Med Health Care Philos 2024:10.1007/s11019-024-10203-0. [PMID: 38649633 DOI: 10.1007/s11019-024-10203-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/25/2024]
Abstract
Almost all countries and fertility clinics impose age limits on women who want to become pregnant through Assisted Reproductive Technologies (ART). Age limits for aspiring fathers, however, are much less common and remain a topic of debate. This article departs from the principle of reproductive autonomy and a conditional positive right to receive ART, and asks whether there are convincing arguments to also impose age limits on aspiring fathers. After considering three consequentialist approaches to justifying age limits for aspiring fathers, we take in a concrete normative stance by concluding that those are not strong enough to justify such cut-offs. We reinforce our position by drawing a comparison between the case of a 39-year-old woman who wants to become a single mother via a sperm donor on the one hand, and on the other hand the same woman who wants to have a child with a 64-year-old man who she loves and who is willing to care for the child as long as he is able to. We conclude that, as long as appropriate precautions are taken to protect the welfare of the future child, couples who want to receive fertility treatment should never be limited on the basis of the age of the (male) partner. An absence of age limits for men would respect the reproductive autonomy of both the man and the woman.
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Affiliation(s)
- Steven R Piek
- Bioethics Institute Ghent, Department of Philosophy and Moral Sciences, Ghent University, Blandijnberg 2, Ghent, 9000, Belgium.
| | - Andrea Martani
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, Basel, 4056, Switzerland
| | - Guido Pennings
- Bioethics Institute Ghent, Department of Philosophy and Moral Sciences, Ghent University, Blandijnberg 2, Ghent, 9000, Belgium
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Piek SR, Pennings G, Provoost V. Age-based restrictions on reproductive care: discerning the arbitrary from the necessary. Theor Med Bioeth 2024; 45:41-56. [PMID: 37819446 DOI: 10.1007/s11017-023-09648-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 10/13/2023]
Abstract
Policies that determine whether someone is allowed access to reproductive healthcare or not vary widely among countries, especially in their age requirements. This raises the suspicion of arbitrariness, especially because often no underlying justification is provided. In this article, we pose the question-under which circumstances is it morally acceptable to use age for policy and legislation in the first place? We start from the notion that everyone has a conditional positive right to fertility treatment. Subsequently, we set off to formulate a framework that helps to determine who should be excluded from treatment nonetheless. The framework's three core elements are: choosing and ethically justifying exclusion criteria (target), determining the actual limit between in- and exclusion (cut-off), and selecting variables that help to predict the exclusion criteria via correlation (as they are not directly measurable) (proxy). This framework allows us to show that referring to age in policy and legislation is only ethically justifiable if there is a sufficiently strong correlation with a non-directly measurable exclusion criterion. Moreover, since age is only one of many predicting variables, it should therefore not be ascribed any special status. Finally, our framework may be used as an argumentative scheme to critically assess the ethical legitimacy of policies that regulate access to (fertility) treatments in general.
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Affiliation(s)
- Steven R Piek
- Bioethics Institute Ghent, Department of Philosophy and Moral Sciences, Ghent University, Blandijnberg 2, 9000, Ghent, Belgium.
| | - Guido Pennings
- Bioethics Institute Ghent, Department of Philosophy and Moral Sciences, Ghent University, Blandijnberg 2, 9000, Ghent, Belgium
| | - Veerle Provoost
- Bioethics Institute Ghent, Department of Philosophy and Moral Sciences, Ghent University, Blandijnberg 2, 9000, Ghent, Belgium
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Bolt SH, Maas AJBM, Indekeu A, van Nistelrooij I. Legal age limits in accessing donor information: experiences of donor-conceived people, parents, sperm donors and counsellors. Reprod Biomed Online 2024; 48:103846. [PMID: 38579663 DOI: 10.1016/j.rbmo.2024.103846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 04/07/2024]
Abstract
RESEARCH QUESTION What are the lived experiences of donor-conceived people, parents, sperm donors and counsellors related to legal age limits on accessing donor information in the Netherlands? DESIGN A phenomenological study was carried out that included 20 donor-conceived individuals, 15 parents, 6 sperm donors and 5 counsellors. Data were collected through online qualitative in-depth interviews and focus groups. The data were analysed using Dahlberg's Reflective Lifeworld Approach. RESULTS The results show how: (i) age limits create challenges related to dependency, autonomy and loyalty to parents; (ii) donor information can be important for identity development, which looks different at different ages; (iii) inaccessible information can lead to unfair loss and may be perceived as negative; (iv) relational stability provides a good foundation for dealing with the (in)accessibility of donor information; (v) procedural barriers and age limits increase the inaccessibility of donor information; and (vi) comprehensive counselling is desired for donor-conceived individuals, parents and donors. CONCLUSIONS This study shows that legal age limits on accessing donor information can lead to several negative consequences. The age limits focus on one individual, which is not appropriate for questions about ancestry that always pertain to a relational network. Counselling should be tailored to the child's needs, and the child's family should be involved. Furthermore, the donor should receive independent counselling.
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Affiliation(s)
| | | | - Astrid Indekeu
- Fiom, 's-Hertogenbosch, The Netherlands.; Centre for Sociological Research, KU Leuven, Leuven, Belgium
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Althammer A, Prückner S, Gehring GC, Lieftüchter V, Trentzsch H, Hoffmann F. Systemic review of age brackets in pediatric emergency medicine literature and the development of a universal age classification for pediatric emergency patients - the Munich Age Classification System (MACS). BMC Emerg Med 2023; 23:77. [PMID: 37491219 PMCID: PMC10369835 DOI: 10.1186/s12873-023-00851-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/14/2023] [Indexed: 07/27/2023] Open
Abstract
Currently arbitrary, inconsistent and non-evidence-based age cutoffs are used in the literature to classify pediatric emergencies. None of these classifications have valid medical rationale. This leads to confusion and poor comparability of the different study results. To clarify this problem, this paper presents a systematic review of the commonly used age limits from 115 relevant articles. In the literature search 6226 articles were screened. To be included, the articles had to address the following three topics: "health services research in emergency medicine", "pediatrics" and "age as a differentiator". Physiologic and anatomic principles with reference to emergency medicine were used to solve the problem to create a medically based age classification for the first time.The Munich Age Classification System (MACS) presented in this paper is thus consistent with previous literature and is based on medical evidence. In the future, MAC should lead to ensure that a uniform classification is used. This will allow a better comparability of study results and enable meta-analyses across studies.
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Affiliation(s)
- Alexander Althammer
- Institut für Notfallmedizin und Medizinmanagement (INM), Ludwig-Maximilians-University, Schillerstr. 53, 80336, Munich, Germany.
- Department of Anesthesiology, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.
| | - Stephan Prückner
- Institut für Notfallmedizin und Medizinmanagement (INM), Ludwig-Maximilians-University, Schillerstr. 53, 80336, Munich, Germany
| | - Geogr Christian Gehring
- Institut für Notfallmedizin und Medizinmanagement (INM), Ludwig-Maximilians-University, Schillerstr. 53, 80336, Munich, Germany
| | - Victoria Lieftüchter
- Pediatric Intensive Care and Emergency Medicine, Dr. von Hauner Children's Hospital, Ludwig- Maximilians-University, Lindwurmstraße 4, 80337, Munich, Germany
| | - Heiko Trentzsch
- Institut für Notfallmedizin und Medizinmanagement (INM), Ludwig-Maximilians-University, Schillerstr. 53, 80336, Munich, Germany
| | - Florian Hoffmann
- Pediatric Intensive Care and Emergency Medicine, Dr. von Hauner Children's Hospital, Ludwig- Maximilians-University, Lindwurmstraße 4, 80337, Munich, Germany
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Abstract
This report is an ethical analysis based on both facts and values. In in vitro fertilization (IVF), there is an intricate interaction between rapid scientific development and changing societal values. In most countries, the ethical discussion is no longer on whether or not IVF in itself is ethically justifiable. Therefore, in this review, I discuss other ethical aspects that have emerged since IVF was first introduced, such as upper age limits, 'ownership' of gametes and embryos, IVF in single women and same-sex couples, preimplantatory genetic testing, social egg freezing, commercialization, public funding, and prioritization of IVF. Despite secularization, since religion still plays an important role in regulation and practices of IVF in many countries, positions on IVF among the world religions are summarized. Decision-making concerning IVF cannot be based only on clinical and economic considerations; these cannot be disentangled from ethical principles. Many concerns regarding the costs, effects, and safety of IVF subtly transcend into more complex questions about what it means to society to bear and give birth to children.
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Affiliation(s)
- Kjell Asplund
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- CONTACT Kjell Asplund Department of Public Health and Clinical Medicine, Umeå University, Reimersholmsgatan 59, 11740 Stockholm, Sweden
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Abstract
Providers specializing in reproductive medicine are treating increasing numbers of women pursuing parenthood in their 40s, 50s, and beyond. The rise in later-life parenting can be linked to factors ranging from the advent of assisted reproductive technologies and donor oocytes to the highly publicized pregnancies of older celebrities. We explore the medical and psychosocial implications of this trend for both older parents and their children. We also discuss ethical arguments regarding older parents' access to fertility care, existing professional guidelines, and both public and provider opinions about setting age limits for fertility treatment. Finally, we share preliminary considerations of whether age policies should be established, applied to men as well as women, and standardized or considered on a case-by-case basis.
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Affiliation(s)
- Julianne E Zweifel
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 2365 Deming Way, Middleton, WI, 53562, USA.
| | - Julia T Woodward
- Department of Psychiatry & Behavioral Sciences, Department of Obstetrics & Gynecology, Duke University Health System, Durham, USA
| | - Robert W Rebar
- Department of Obstetrics and Gynecology, Homer Stryker M.D. School of Medicine, Western Michigan University, Kalamazoo, MI, USA
| | - Mark V Sauer
- Department of Obstetrics, Gynecology & Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
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