Tremellen Kelton, Savulescu Julian
Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, UK; Repromed, 180 Fullarton Road, Dulwich, South Australia, Australia.
Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, UK.
Reprod Biomed Online. 2015 Jan;30(1):6-13. doi: 10.1016/j.rbmo.2014.10.001. Epub 2014 Oct 13.
Conception of a child using cryopreserved sperm from a deceased man is generally considered ethically sound provided explicit consent for its use has been made, thereby protecting the man's autonomy. When death is sudden (trauma, unexpected illness), explicit consent is not possible, thereby preventing posthumous sperm procurement (PSP) and conception according to current European Society of Human Reproduction and Embryology and the American Society for Reproductive Medicine guidelines. Here, we argue that autonomy of a deceased person should not be considered the paramount ethical concern, but rather consideration of the welfare of the living (widow and prospective child) should be the primary focus. Posthumous conception can bring significant advantages to the widow and her resulting child, with most men supporting such practice. We suggest that a deceased man can benefit from posthumous conception (continuation of his 'bloodline', allowing his widow's wishes for a child to be satisfied), and has a moral duty to allow his widow access to his sperm, if she so wishes, unless he clearly indicated that he did not want children when alive. We outline the arguments favouring presumed consent over implied or proxy consent, plus practical considerations for recording men's wishes to opt-out of posthumous conception.
如果已获得明确同意使用已故男子的冷冻精子来孕育孩子，那么通常认为这种做法在伦理上是合理的，从而保护了该男子的自主权。当死亡是突然发生的（如外伤、突发疾病）时，就无法获得明确同意，因此根据当前欧洲人类生殖与胚胎学会以及美国生殖医学学会的指导方针，无法进行死后精子采集（PSP）和受孕。在此，我们认为不应将已故者的自主权视为首要的伦理考量，而应将对生者（寡妇和未来的孩子）福祉的考量作为主要重点。死后受孕可以给寡妇及其所生孩子带来显著益处，大多数男性也支持这种做法。我们认为已故男子可以从死后受孕中受益（延续他的“血脉”，满足其寡妇想要孩子的愿望），并且如果他的寡妇有此意愿，除非他在生前明确表示不想要孩子，否则他有道德义务允许其寡妇获取他的精子。我们概述了支持推定同意而非默示或代理同意的论据，以及记录男性选择不进行死后受孕意愿的实际考量。
