Jones Georgina L, Folan Anne-Mariead, Phillips Bob, Anderson Richard A, Ives Jonathan
G Jones, Leeds Beckett University, Leeds, United Kingdom of Great Britain and Northern Ireland.
A Folan, Leeds, United Kingdom of Great Britain and Northern Ireland.
Reprod Fertil. 2023 Sep 1;4(4). doi: 10.1530/RAF-23-0047.
In the context of a cancer diagnosis, fertility preservation interventions are used to mitigate the potential impact of gonadotoxic cancer treatment upon fertility. They provide patients with cancer the option to freeze their reproductive material to have their own biological child following treatment. The evidence suggests some clinicians are less likely to have fertility preservation discussions with patients who have an aggressive or metastatic cancer which has a poor prognosis. Although this is contrary to current policy recommendations, there is a lack of guidance relating to offering fertility preservation in the context of a poor prognosis to support clinicians. Controversy surrounds posthumous reproduction, and whether the wishes of the cancer patient, when living and deceased should take precedence over others' wellbeing. We consider the question of whether cancer patients with a poor prognosis should be offered FP from an ethics perspective. We structure the paper around key arguments to which multiple ethical principles might pertain, first establishing a central argument in favour of offering fertility preservation based on respect for autonomy, before exploring counterarguments. We conclude by proposing that a defeasible assumption should be adopted in favour of offering fertility preservation to all cancer patients who might benefit from it. It is important to recognise that patients could benefit from fertility preservation in many ways, and these are not limited to having a parenting experience. The burden of proof rests on the clinician in collaboration with their multi-disciplinary team, to show that there are good grounds for withholding the offer.
在癌症诊断的背景下，生育力保存干预措施用于减轻性腺毒性癌症治疗对生育力的潜在影响。这些措施为癌症患者提供了冷冻其生殖材料的选择，以便在治疗后拥有自己的亲生孩子。有证据表明，一些临床医生不太可能与患有侵袭性或转移性癌症且预后较差的患者讨论生育力保存问题。尽管这与当前的政策建议相悖，但在预后较差的情况下提供生育力保存方面缺乏指导以支持临床医生。围绕死后生殖存在争议，以及癌症患者生前和死后的意愿是否应优先于他人的福祉。我们从伦理角度考虑预后较差的癌症患者是否应接受生育力保存的问题。我们围绕多个伦理原则可能适用的关键论点构建本文，首先基于对自主权的尊重确立支持提供生育力保存的核心论点，然后探讨反驳论点。我们最后提议应采用一个可废止的假设，支持向所有可能从中受益的癌症患者提供生育力保存。重要的是要认识到患者可以从生育力保存中以多种方式受益，而且这些方式不限于拥有为人父母的经历。证明责任在于临床医生及其多学科团队，以表明有充分理由拒绝提供生育力保存。
