Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
Children's Bioethics Centre, Royal Children's Hospital, Melbourne, Victoria, Australia.
J Med Ethics. 2018 Jan;44(1):27-31. doi: 10.1136/medethics-2016-104042. Epub 2017 Oct 30.
Young children with cancer are treated with interventions that can have a high risk of compromising their reproductive potential. 'Fertility preservation' for children who have not yet reached puberty involves surgically removing and cryopreserving reproductive tissue prior to treatment in the expectation that strategies for the use of this tissue will be developed in the future. Fertility preservation for prepubertal children is ethically complex because the techniques largely lack proven efficacy for this age group. There is professional difference of opinion about whether it is ethical to offer such 'experimental' procedures. The question addressed in this paper is: when, if ever, is it ethically justifiable to offer fertility preservation surgery to prepubertal children? We present the ethical concerns about prepubertal fertility preservation, drawing both on existing literature and our experience discussing this issue with clinicians in clinical ethics case consultations. We argue that offering the procedure is ethically justifiable in certain circumstances. For many children, the balance of benefits and burdens is such that the procedure is ethically permissible but not ethically required; when the procedure is medically safe, it is the parents' decision to make, with appropriate information and guidance from the treating clinicians. We suggest that clinical ethics support processes are necessary to assist clinicians to engage with the ethical complexity of prepubertal fertility preservation and describe the framework that has been integrated into the pathway of care for patients and families attending the Royal Children's Hospital in Melbourne, Australia.
患有癌症的幼儿接受的干预措施可能有很高的风险损害其生殖潜能。对于尚未进入青春期的儿童，“生育力保存”是指在治疗前通过手术切除和冷冻保存生殖组织，以期未来能开发出利用这种组织的策略。对于青春期前儿童的生育力保存在伦理上是复杂的，因为这些技术在该年龄段的疗效很大程度上缺乏确凿证据。是否为儿童提供这种“实验性”手术在伦理上是否可行，存在专业意见分歧。本文探讨的问题是：何时在伦理上可以为青春期前儿童提供生育力保存手术？我们提出了关于青春期前生育力保存的伦理问题，既参考了现有文献，也借鉴了我们在临床伦理案例咨询中与临床医生讨论这个问题的经验。我们认为，在某些情况下，提供该程序在伦理上是合理的。对于许多儿童来说，利益和负担的平衡使得该程序在伦理上是允许的，但不是必需的；当该程序在医学上是安全的时，这是家长的决定，需要治疗医生提供适当的信息和指导。我们建议，临床伦理支持流程是必要的，可以帮助临床医生应对青春期前生育力保存的伦理复杂性，并描述已融入澳大利亚墨尔本皇家儿童医院患者和家庭护理途径的框架。
