Affdal Aliya Oulaya, Ravitsky Vardit
J Int Bioethique Ethique Sci. 2019 Nov 27;Vol. 30(3):159-177. doi: 10.3917/jibes.303.0159.
Chemotherapy and radiotherapy have increased the life expectancy of cancer patients but may cause premature ovarian failure and irreversible loss of fertility. In the context of childhood cancers, it is now acknowledged that possible negative effects of treatment on future reproductive autonomy are a major concern. While a few options are open to patients post-puberty, the only option currently open to prepubescent girls is cryopreservation of ovarian tissue and subsequent transplantation. Yet, this procedure raises ethical concerns related to its experimental nature and to risks involved in surgery and general anesthesia. In addition, the risk of malignant cells being reintroduced in the future following autologous transplantation of the ovarian tissue is still poorly evaluated. A number of ethical issues arise surrounding this procedure. While the girl's future reproductive autonomy is at stake, it is important to also consider risks associated with the procedure. Fertility preservation through cryopreservation of ovarian tissue thus raises a conflict between the principles of beneficence and non-maleficence. We argue that the ethical complexity surrounding fertility preservation for prepubescent girls should be resolved by applying the principle of "the child's right to an open future". We propose to consider 'beneficence' through the lens of the reproductive autonomy and her potentialin becoming a genetic parent.
化疗和放疗延长了癌症患者的预期寿命,但可能导致卵巢早衰和生育能力的不可逆丧失。在儿童癌症方面,目前人们认识到治疗对未来生殖自主权可能产生的负面影响是一个主要问题。虽然青春期后的患者有一些选择,但目前青春期前女孩唯一的选择是冷冻保存卵巢组织并随后进行移植。然而,这一程序引发了与其实验性质以及手术和全身麻醉所涉及风险相关的伦理问题。此外,卵巢组织自体移植后未来重新引入恶性细胞的风险仍评估不足。围绕这一程序出现了许多伦理问题。虽然女孩未来的生殖自主权受到威胁,但同样重要的是要考虑与该程序相关的风险。因此,通过冷冻保存卵巢组织来保存生育能力引发了行善原则和不伤害原则之间的冲突。我们认为,围绕青春期前女孩生育能力保存的伦理复杂性应通过应用“儿童拥有开放未来的权利”这一原则来解决。我们建议从生殖自主权及其成为基因父母的潜力的角度来考虑“行善”。