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      Presuming consent in the ethics of posthumous sperm procurement and conception

      research-article
      Reproductive Biomedicine & Society Online
      Elsevier
      conception, consent, ethics, moral, posthumous, sperm

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          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 2015. According to their radical proposal, the surviving partner’s wishes are, in effect, the only condition that needs to be considered for there to be a legitimate moral case for these procedures: the default should be presumed consent to the procedures, whether or not the agent did consent or would have consented. The present paper argues that Tremellen and Savulescu’s case for this position is flawed, but offers a reconstruction that articulates what may well be a hidden, and perhaps reasonable, assumption behind the argument. 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.

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          Most cited references21

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          Posthumous sperm retrieval: analysis of time interval to harvest sperm.

          Current recommendations regarding posthumous sperm retrieval (PSR) are based on a small number of cases. Our purpose was to determine the time interval from death to a successful procedure. Seventeen consecutive PSR procedures in 14 deceased and 3 neurologically brain-dead patients at two male infertility centres [Sheba Medical Center (SMC), Tel-Hashomer, Israel and University of California San Francisco (UCSF), San Francisco, CA, USA] were analysed. Main outcome measures were retrieval of vital sperm, pregnancies and births. PSR methods included resection of testis and epididymis (n = 8), en-block excision of testis, epididymis and proximal vas deferens with vasal irrigation (n = 6), electroejaculation (EEJ) (n = 2) and epididymectomy (n = 1). PSR was performed 7.5-36 h after death. Sperm was retrieved in all cases and was motile in 14 cases. In two cases, testicular and epididymal tissues were cryopreserved without sperm evaluation, and in one case, no motility was detected. IVF and ICSI were performed in two cases in which sperm had been retrieved 30 h after death, and both resulted in pregnancies and live births. Viable sperm is obtainable with PSR well after the currently recommended 24-h time interval. PSR should be considered up to 36 h after death, following appropriate evaluation. No correlation was found between cause of death and chance for successful sperm retrieval.
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            The bioethical principles and Confucius' moral philosophy.

            This paper examines whether the modern bioethical principles of respect for autonomy, beneficence, non-maleficence, and justice proposed by Beauchamp and Childress are existent in, compatible with, or acceptable to the leading Chinese moral philosophy-the ethics of Confucius. The author concludes that the moral values which the four prima facie principles uphold are expressly identifiable in Confucius' teachings. However, Confucius' emphasis on the filial piety, family values, the "love of gradation", altruism of people, and the "role specified relation oriented ethics" will inevitably influence the "specification" and application of these bioethical principles and hence tend to grant "beneficence" a favourable position that diminishes the respect for individual rights and autonomy. In contrast, the centrality of respect for autonomy and its stance of "first among equals" are more and more stressed in Western liberal viewpoints. Nevertheless, if the Confucian "doctrine of Mean" (chung-yung) and a balanced "two dimensional personhood" approach are properly employed, this will require both theorists and clinicians, who are facing medical ethical dilemmas, of searching to attain due mean out of competing moral principles thus preventing "giving beneficence a priority" or "asserting autonomy must triumph".
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              Posthumous sperm retrieval for the purpose of later insemination or IVF in Israel: an ethical and psychosocial critique.

              R. Landau (2004)
              In October 2003, the Attorney General of the Government of Israel published guidelines allowing posthumous sperm retrieval for the purpose of later insemination or IVF by the surviving female partner. This paper presents an ethical and psycho-social critique of the guidelines, which challenges their basic premise that personal autonomy over-rides any other ethical principle and argues that the autonomy of the adult should not over-ride the well-being of the offspring. It also shows that, despite the centrality of autonomy in the guidelines, they actually infringe on the autonomy of the deceased, and pose challenges to that of the surviving partner. It questions the propriety and very possibility of ascertaining the 'presumed wishes' of the deceased for a posthumous child. Finally, it argues against the document's presentation of posthumous sperm retrieval as a medical procedure and contends that, on the contrary, medicine and science are suborned to the exploitation of the dead.
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                Author and article information

                Contributors
                Journal
                Reprod Biomed Soc Online
                Reprod Biomed Soc Online
                Reproductive Biomedicine & Society Online
                Elsevier
                2405-6618
                27 May 2016
                December 2015
                27 May 2016
                : 1
                : 2
                : 123-130
                Affiliations
                Philosophy, School of Humanities, The University of Auckland, New Zealand
                Article
                S2405-6618(16)30008-9
                10.1016/j.rbms.2016.05.003
                6001348
                e5cd79cc-d2ba-4b8b-9d02-5161b22ef17a
                © 2016 The Author

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 2 December 2015
                : 19 May 2016
                Categories
                Philosophy and Politics

                conception,consent,ethics,moral,posthumous,sperm
                conception, consent, ethics, moral, posthumous, sperm

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