Some commentators also worry about the more general potential of such a procedure to harm the child see, e. Following a decision being made by the grieving parties that PSP is desirable, local legal considerations must be addressed. A discussion supporting presumed consent for posthumous sperm procurement and conception. Have these measures had any influence over the legal successional devolution? Marx a elaborat și o teorie a valorii : valoarea este expresia cantității de muncă conținută de un produs. In the first place, the appeal in their Specific Argument to statistical evidence concerning what men want is quite uncompelling.
Received Dec 2; Accepted May Abstract This paper compares standard conceptions of consent with the conception of consent defended by Kelton Tremellen and Julian Savulescu in their attempt to re-orient the ethical debate around posthumous sperm procurement and conception, as published in Reproductive BioMedicine Online in But while the new argument appears more promising, the reconstruction also suggests that the position of presumed consent is currently unlikely to be acceptable as policy.
KEYWORDS: conception, consent, ethics, moral, posthumous, sperm Introduction Posthumous sperm procurement PSP and the use of posthumously procured sperm in IVF involve the collection of sperm from a recently deceased male and its use for the purpose of posthumous reproduction.
Sinceadvances in assisted reproductive technology, and in particular the high success rates attributed to intracytoplasmic sperm injection ICSIhave made PSP followed by IVF increasingly feasible dating online frederick md a way to allow someone to conceive a child despite the death of the biological father. But it has also highlighted a number of ethical issues, such as whether these procedures shows proper regard for the well-being, needs and dignity of the orphaned child Landau, and, more fundamentally, whether proper regard for the autonomy of the deceased always requires his explicit consent to the procedures prior to death.
The paper is organized as follows. The next section briefly describes some of the dating online frederick md background relevant to the ethical discussion surrounding PSP and PSP-based conception, and then outlines the standard positions on consent.
This allows me to compare their non-standard model of what is at stake dating kk the more widely accepted standard model. The concluding section asks how the debate should be resolved. The standard debate PSP is generally performed with urgency following death.
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Following a decision being made by the grieving parties that PSP is desirable, local legal considerations must be addressed. A medical specialist with the requisite skills to extract sperm from the dating online frederick md deferens, epididymis or testis, or to perform an orchiectomy, is then required to attend the deceased.
Following extraction, the sperm or testicular tissue is transported to a specialist IVF laboratory where it is processed and frozen for future use. The possibility of successful conception depends on a multitude of human factors, but particularly the viability of the retrieved sperm.
Sperm viability is dependent on the dating online frederick md interval between death and sperm retrieval, and possibly also the temperature at which the body has been stored Tash et al. Twenty-four hours has been suggested as an appropriate time interval during which retrieval is most likely to be successful Land and Ross,Shefi et al. The resulting embryo s are then cultured for up to 5 days before transfer into the uterus.
The process above demonstrates why it is important that there not be a lengthy legal process of negotiation or inquiry into whether the process of procuring sperm is allowed to go ahead; delays could make the path to IVF impossible. This does not mean that deciding whether it is permissible to proceed to IVF once sperm have been harvested should also be a quick process, dating online frederick md this decision may depend on ethically sensitive matters that require much more time to resolve.
This will be true, for dating online frederick md, if it first needs to be shown that the deceased would have wanted to have a child on the basis of PSP suppose that the standard of evidence for such a demonstration has been set at a very high level. As we will see below, Tremellen and Savulescu reject the requirement that those making the decision need to know that the deceased would have consented to PSP and conception.
For many others, however, the only kind of knowledge that suffices is proof dating online frederick md the deceased explicitly consented to the procedures. This is not the only important ethical question, of course. The consequences for any offspring will also need to be considered carefully. Some commentators also worry about the more general potential of such a procedure to harm the child see, e.
Strong et al. All agree that more studies are needed to determine the impact on the well-being of children born from the procedure. Returning to the question of consent, it is clear that the most straightforward way of showing that the deceased would have consented to PSP and conception is to show that he explicitly consented to the procedures before death.
This is certainly the test insisted on in most western legal jurisdictions that permit the procedures. Explicit consent in this sense should be understood as informed consent, where this includes competency, disclosure, understanding, voluntariness and consent Beauchamp and Childress,perhaps with special online dating procentaje placed on the means and depth of disclosure see especially the discussion in Strong,and Hostiuc and Curca, Of course, explicit consent of this type is not intended to override all other considerations.
So while explicit consent dating online frederick md considered necessary in most legal jurisdictions that permit the procedures, explicit consent on its own is not considered sufficient. But some ethicists think that that the test of explicit consent should not even be a necessary condition, because the test is too demanding. Men who die suddenly, for example in accidents, are not likely to have thought about giving explicit consent to such a procedures, even dating online frederick md they may well have wanted their partners to have their child under these circumstances.
There may even be some evidence of this: it may be known, for example, that the couple had discussed such a possibility. This has led a number of ethicists to propose another model of consent: implied or inferred consent, the idea that it is enough that the deceased would, on the balance of probabilities, have consented to the procedures had he been presented with the relevant facts pre-mortem and been able to discuss the matter with his partner.
The problem facing such a test of implied consent is obvious, however. Even if a man was eager to be a father, in the normal sense, that would normally include both begetting a child biological fatherhood and contributing to its upbringing social fatherhood and to disconnect the two could conceivably undermine his paternal desires.
As is sometimes pointed out, the claim that there is implied consent to a procedure dating online frederick md not imply that anyone has in fact consented, but is simply the claim that a certain counterfactual is true: in the present case, that the deceased male would have met the viteza datând surabaya of informed consent had the matter been put to him.
The evidence for such a counterfactual is in most cases far from reliable, however, given the nature of the case. What if the partner states that the deceased had explicitly said that he would want sperm retrieval after death, an account perhaps corroborated by some family members?
They have a motivation to hide the truth, or put a certain spin on things the deceased might have said or done Bahadur,Bahadur,Schiff,Strong,Strong et al. Strong,argues that if there is indeed corroboration from family members this may in some cases overcome the problem of bias, but not when there is no one to corroborate the account. That crucial ambiguity makes it quite unclear what would constitute reasonable grounds for determining that a man had wanted posthumous reproduction, if he had never discussed the matter.
Nearly a quarter of women incorrectly guessed the wishes of their partners Nakhuda et al. Existing judicial decisions in most western jurisdictions tend to reflect such doubts about the notion of implied consent.
Indeed, some countries France, Germany, Sweden, Canada have an outright ban on the procedure, but where PSP is permitted the norm is a requirement of explicit consent. Ethicists are more divided. Some think that under a policy of implied consent the dating online frederick md of evidence required should be set so high that little short of explicit consent would suffice. Others incline to a softer standard of evidence. However, it would be possible though it has not been evaluated to ascertain the hypothetical desires of men who are still alive in relation to the possibility of biologically fathering children after death.
Others will not set the bar so high. That, in brief, is the present state of the debate about the kind of consent that is needed for an ethical case to be made for PSP and PSP-based conception. Given the debate, it is scarcely surprising that there is variation in the legal situation across countries, but with a predisposition towards a conservative approach that insists, at a minimum, on explicit informed consent rather than implied consent.
A challenge to the standard debate In a recent paper Kelton Tremellen and Julian Savulescu claim that the standard dating online frederick md debate is seriously flawed Tremellen and Savulescu, ; TS, for short. They argue instead for the option of presumed consent: not actual or implied consent, but the thought that the relevant authorities should act as if consent had been granted in the absence of written evidence to the contrary. They begin by providing a number of reasons for taking PSP and PSP-based conception to be ethically justifiable even without explicit consent.
Secondly, PSP benefits the donor, since the deceased gains a benefit prior to death through the benefit of motherhood gained by his partner after his death.
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In support, Tremellen and Savulescu cite an analogy with life insurance. Implementing a policy of presumed consent would be an easy way to allow the wishes of the majority to be respected.
They mitigate this position by acknowledging that the acceptability of posthumous conception is likely to vary according to religion and culture, and that more surveys are needed. Secondly, they reject, for the kinds of reasons we canvassed earlier, the view that a reliance on implied consent is an adequate alternative to explicit consent.
By contrast, it makes no sense to talk about the child being harmed through allowing these procedures dating online frederick md there would have been no child without the procedures.
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I will have little to say about the final sections of the paper, which are devoted to more practical matters. Having argued that easier access to PSP and posthumous conception on the basis of presumed consent is desirable on moral grounds, Tremellen and Savulescu remind their readers that there is a very low level engagement with these procedures under current regimes of consent Bahadur,Kroon et al.
Because implementing such a policy requires professional societies to modify their position statements dating online frederick md posthumous conception and requires assisted reproduction units to develop adequate treatment protocols, they conclude their discussion by describing and defending salient features of the kind of opt-out of scheme they themselves think should implement the idea of presumed consent, including a proposed clinical protocol for PSP-based conception.
Evaluation and reconstruction The position that Tremellen and Savulescu espouse is clearly far more liberal than any of the existing positions we have mentioned; more liberal, even, than the position adopted in Israel since there is no need on the Tremellen-Savulescu view for evidence that the couple were planning to have children.
Unfortunately, however, they leave their arguments for this position in fairly sketchy form, so it is difficult to know how they would respond to certain obvious objections. I will focus on just three points, but they seem to me pivotal ones. In the first place, the appeal in their Specific Argument to statistical evidence concerning what men want is quite uncompelling. The surveys to which Tremellen and Savulescu appeal establish no such standard.
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These involve men who have had their sperm frozen as well as couples trying to conceive, groups that are dissimilar from the general population in ways that are clearly relevant to the issue. If a survey-based argument invoking the hypothetical desires of men is to have any force, we need statistically more representative samples.
As it turns out, recent work on this issue does suggest that in the USA, at least, there is significant support among men and women for allowing their partners access to their gametes after death for the purpose of posthumous conception Hans, Suppose that this result is shown to be robust, dating online frederick md that similar results can be obtained in dating online frederick md western jurisdictions.
In particular, they think that considerations dating online frederick md agent autonomy are swamped by other-regarding considerations in this case, a view that also motivates the various deontological considerations to which they appeal e.
It is at this point that the overall argument for their position is at its most unsatisfactory. It is well known, however, that the existence condition has strikingly counterintuitive consequences; it implies, for example, that instantaneous killings do not harm, and do not affect the interests, of their victims, since there is no stage of their existence during which the alleged victim suffers the harm.
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The condition also cuts across conventional wisdom, both legal and moral, about signed deeds that concern events in which the signer has an interest but which will occur after the death of the person signing. Wills and life insurance policies are an example. Even though the person will no longer exist at the time at which such a deed is actioned, there is a strong intuition that the no-longer-existing person continues to have interests that we are morally and legally required to take into account.
A number of moral philosophers make room for such intuitions in their own account of posthumous harm see, for example, Feinberg,and Grover, It dating online frederick md easy to gain the impression that Tremellen and Savulescu think such accounts are bound to be philosophically flawed — unless a subject exists when his interests are allegedly infringed there simply is no subject to worry about.
But that suggests far too broad a principle. It suggests, in particular, that we can stand in no relation now to something that does not exist now. But the consensus among philosophers, no less than among ordinary folk, overwhelmingly goes the other way, even if there is debate among philosophers about which metaphysical framework best accommodates such cross-temporal facts.
In fact, some of the other arguments that Tremellen and Savulescu use depend on the very possibility of other cross-temporal attributions to dating online frederick md who no longer exist.
Prior dating online frederick md death, there are no actions that can confer a benefit; and after death there is no person to benefit. Whatever harm there is, it is not inflicted until after the man has died and his widow makes a request that is then denied; and at this point there is no person to inflict the harm. Their treatment of the interests of the deceased appears to be based on a simplistic metaphysics, and their consequent assignment of low weight to agent autonomy quite uncompelling.
It is true that the policy Tremellen and Savulescu support with their argument contains an opt-out provision, and so allows men to deny consent to the procedure. This appears to be a concession to the idea of autonomy on the part of Tremellen and Savulescu, and it may be tempting to think that such a concession blunts the force of the above criticism.
But it does no such thing. If anything, it leaves us with a puzzle. Of course, an opt-out scheme that dating online frederick md registered wishes to be overridden in this way may prove dating online frederick md be quite unacceptable from the point of view of healthcare politics, but that is a different matter.
Expediency aside, such a scheme would seem best to accord with the ethical principles to which Tremellen and Savulescu subscribe. But nothing I have said shows that the position they espouse is thereby indefensible. Because Tremellen and Savulescu nowhere articulate this assumption, it is difficult to be sure of the details and so my account will be schematic.