A presentation for: Warner Pacific College Health Care Ethics Professor Cosmo Salibello

Bioethical Considerations Relating to Posthumous Reproduction A presentation for: Warner Pacific College Health Care Ethics Professor Cosmo Salibello Presented by: Kevin Armstrong, Julie Baker, and Karleen Aichele December 17, 2013 Image credited to: http://www.cbsnews.com/news/dead-girls-family-harvests-her-eggs-was-it-unethical/

Meet Chen Aida Ayash A beautiful young Israeli of 17 years Image credited to: http://www.dailymail.co.uk/news/article-2024990/Chen-Aida-Ayashs-grieving-family-wins-right-harvest-eggs.htm

Bioethical Considerations Relating to Posthumous Reproduction The Story… • August 3, 2011. • Hit by a car outside of Jerusalem. • She dies. • An ethics debate begins. But why should this young lady a half a world away become the center of a medical ethics debate? Image credited to: http://www.cbsnews.com/news/dead-girls-family-harvests-her-eggs-was-it-unethical & http://www.dailymail.co.uk/news/article-2024990/Chen-Aida-Ayashs-grieving-family-wins-right-harvest-eggs.htm /

Bioethical Considerations Relating to Posthumous Reproduction The Story continues… • Parents could legally donate organs. • Parents wanted to harvest her eggs. • The hospital was reluctant. • Her parents were adamant. • The courts had to intervene. Image credited to: http://www.cbsnews.com/news/dead-girls-family-harvests-her-eggs-was-it-unethical & http://www.dailymail.co.uk/news/article-2024990/Chen-Aida-Ayashs-grieving-family-wins-right-harvest-eggs.htm /

Bioethical Considerations Relating to Posthumous Reproduction This evening Chen’s story will help illustrate… • Autonomy • Beneficence • Nonmaleficence • Justice Image credited to: http://www.cbsnews.com/news/dead-girls-family-harvests-her-eggs-was-it-unethical/

Bioethical Considerations Relating to Posthumous Reproduction Autonomy… Each rational, competent person be given the right to make medical decisions that affect his or her life. • Would Chen want her biological children to be born after she was dead? (Prof. Daar) • Would she want them to be raised by her parents? • Is informed consent a factor ? Chen was under age - parents decide. • Is her autonomy ceded to a third party surrogate? • Would it be presumptuous for an ethicist to imply that she would not want the opportunity to have children – given no instruction were left? Image credited to: http://www.cbsnews.com/news/dead-girls-family-harvests-her-eggs-was-it-unethical/

Bioethical Considerations Relating to Posthumous Reproduction Beneficence… To do good. Promote benefit. The whole purpose of medical practice is to make lives better. How could this act provide benefit? • It could allow the girl’s family line to continue. • It could allow for the creation of a desperately desired life – a grandchild. • It could give the grandparents the opportunity and joy of raising a grandchild. Image credited to: http://www.cbsnews.com/news/dead-girls-family-harvests-her-eggs-was-it-unethical/

Bioethical Considerations Relating to Posthumous Reproduction Nonmaleficence… If there can no longer be benefit, then there should at the very least be no harm. This asserts an obligation not to inflict harm intentionally on another. • Could it be injurious to the child to be raised by his/her grandparents? • Give grandparents the ability to raise a grandchild. It is not unheard of currently. • Possible acceptance of procedure, but not the “psychosocial aspects” (Dr. Grodin). • “Your mother was dead when you were conceived” (nature/nurture thing working out?) • Should there be a waiting period for grieving? (Bioethicist, U of PA Dr. Arthur Caplan). Image credited to: http://www.cbsnews.com/news/dead-girls-family-harvests-her-eggs-was-it-unethical/

Bioethical Considerations Relating to Posthumous Reproduction Justice… • People should be treated justly, fairly, and equally. • However, justice is based on society and culture. • But if everyone were treated equally many may not consider that fair. • Viability of the eggs - At the time of the case, eggs could not be frozen and remain viable. • Only embryos and sperm could be frozen. • Did the Judge, by granting the eggs frozen but NOT fertilized create a moot point? • The Judge decided there would be not decedents from Chen’s line. • “Using the gametes of a dead child to created another child creates a troubling precedent” (LarieZoloth, director of Bioethics, Northwestern University). Image credited to: http://www.cbsnews.com/news/dead-girls-family-harvests-her-eggs-was-it-unethical/

Bioethical Considerations Relating to Posthumous Reproduction Flip Side… • How would this situation be addressed if the intent of the donation were clear? • What if frozen sperm were involved? • What if the donor knew he may be dying? Image credited to: http://www.cbsnews.com/news/dead-girls-family-harvests-her-eggs-was-it-unethical/

Bioethical Considerations Relating to Posthumous Reproduction The Story… • In 2006 an Israeli man was dying of cancer. • He specifically stated he wanted to be a parent someday. • He asked his parents to store his sperm. • He passed away. • His parents found a woman in her thirties who was actively seeking a donor, but hesitant about anonymousdonors. Image credited to: http://www.cbsnews.com/news/dead-girls-family-harvests-her-eggs-was-it-unethical/

Bioethical Considerations Relating to Posthumous Reproduction The Story continues… • 7 years later, in 2013, this woman he never knew, gave birth to his daughter. • Via the New Family Advocacy Organization (Irit Rosenblum, founder). • Helped prepare/finalize a contract establishing/regulating the relationship. • The courts declared, “…harmonious coming together of the interests of all parties involved…” Image credited to: http://www.cbsnews.com/news/dead-girls-family-harvests-her-eggs-was-it-unethical/

Bioethical Considerations Relating to Posthumous Reproduction How are the four principles applied here? • Autonomy ….. He communicated desire to be a parent and donated his sperm. • Beneficence ...Woman has a child. Man’s parents have a grandchild. • Nonmaleficence …A child is born into an existing family structure. • Justice …….. The courts reconciled bioethical concerns regarding the good of the child and societal normative concepts of what is acceptable use of reproductive technology. Image credited to: http://www.cbsnews.com/news/dead-girls-family-harvests-her-eggs-was-it-unethical/

Bioethical Considerations Relating to Posthumous Reproduction ? Image credited to: http://www.cbsnews.com/news/dead-girls-family-harvests-her-eggs-was-it-unethical/

Bioethical Considerations References Relating to Posthumous Reproduction Conley, M. (2011, August 11). Harvesting dead girl’s eggs raises ethical issues. MedPage Today. Retrieved from http://www.medpagetoday.com/PublicHealthPolicy/Ethics/28009 Eden, D. (2011, August 8). Dead woman’s ova harvested after court okays family request. Haaretz. Retrieved from http://www.haaretz.com/print-edition/news/dead-woman- s-ova-harvested-after-court-okays-family-request-1.377495 Jaslow, R. (2011, August 11). Dead girl’s family harvests her eggs: Was it unethical? CBS News. Retrieved from http://www.cbsnews.com/news/dead-girls-family-harvests-her- eggs-was-it-unethical/ Parks, J. A., & Wike, V. S. (2010). Bioethics in a changing world. Upper Saddle River, N.J.: Prentice Hall. ISBN: 9780136151647. Rimon-Greenspan, H., & Ravitsky, V. (2013, June 17). New frontiers in posthumous reproduction. BioNews. Retrieved from http://www.bionews.org.uk/page_313450.asp Image credited to: http://www.cbsnews.com/news/dead-girls-family-harvests-her-eggs-was-it-unethical/

Image credited to: http://www.cbsnews.com/news/dead-girls-family-harvests-her-eggs-was-it-unethical/

A presentation for: Warner Pacific College Health Care Ethics Professor Cosmo Salibello