History of Urology Forum
Presentation Authors: Michael Ernst*, Sean McGinley, Shervin Badkhshan, Buffalo, NY
Introduction: Postmortem sperm retrieval (PMSR) allows for a blurring of the line between life and death. Artificial insemination is not new; it has been possible in humans for over 200 years. It has become possible for a urologist to procure sperm from a deceased male and use this sperm for posthumous conception, raising complex legal and ethical questions. We seek to highlight these questions and the elusive answers.
Methods: Literature review was performed of medical, legal, and ethical texts to identify relevant historical information about the practical application of PMSR.
Results: "The most important legal issues surrounding PMSR are the right to govern sperm, the property category of sperm, decedent intent, and inheritance rights. Parpalaix v. CECOS (France, 1984) and Hecht v. Superior Court of California (1993) are the foundational cases in PMSR. They address intent of procreation and the transfer of sperm at death. Emergence of sperm donation led to analysis of the property category of sperm in Davis v. Davis (1992) and the Uniform Anatomical Gift Act (1968). In Davis v. Davis the court ruled that cryopreserved pre-embryos held an interim position between other human tissue and persons, not general property. While every situation is different, these important cases set a precedent that in the right circumstance PMSR is legal and provide guiding principles. The Uniform Probate Code (1990) has been used to address inheritance; however, states are encouraged to clarify the issue via legislation.
The chief ethical issue is that of consent of the donor. While consent is often left to proxy or next of kin, PMSR is a special case. Ideal ethical standards suggest "focus on the intent of the decedent and limit any PMSR to specific requests made by the decedent...in writing." When spousal consent is obtained, a 1-year quarantine period to allow bereavement is recommended.
This issue is not unique to the United States. There are full bans on PMSR in many European countries and Canada. The UK allows PMSR, but requires written consent from the deceased. The US has no federal legislation regarding PMSR, leaving the burden on individual clinics and hospitals to address.
Conclusions: There are complex questions about PMSR that must be answered carefully and with sensitivity. The history of this process is one that has been forced to decipher the ownership of gametes, inheritance of an unborn child, and consent of the deceased. Medical, ethical, and legal leaders have taken decades to define guidelines on the use of PMSR. This is a process that will likely need to be repeated as our technological advancements present heretofore unresolved challenges.
Source of Funding: None