The emerging field of oncofertility gives rise to many ethical questions, particularly those focusing on who is offered fertility preservation, how it’s paid for, and what’s done with the reproductive material (eggs, embryos, sperm) after retrieval. These are the most common ethical issues pertaining to fertility preservation and unfortunately, they are no universal answers as each case presents differently and requires a unique solution. In a new article entitled, “Addressing the Most Frequently Asked Questions of a Bioethicist in an Oncofertility Setting,” in Oncofertility Medical Practice: Clinical Issues and Implementation, author Lisa Campo-Engelstein, PhD, examines those questions as a bioethicist within the Oncofertility Consortium.
Who Should Be Offered Fertility Preservation: This question has many layers to it. There are age-based issues concerning minors, and their role in making these types of long-term multifaceted decisions. Along with age concerns comes prognosis concerns. Should we be offering fertility preservation services to cancer patients with a poor prognosis? Studies suggest that talking with patients about fertility preservation gives them hope for a life beyond cancer, and may be a motivating factor in their recovery. Finally, marital status or lack thereof, can be a concern for some insurance providers who are unwilling to provide coverage for individuals who are not married, and to complicate matters even further, they may require that the reproductive material being used come from the couple as well.
Paying for Fertility Preservation: Insurance companies often do no pay for fertility preservation even though fertility loss is a direct result of cancer treatment. According to Dr. Campo-Engelstein, “If health professionals cause harm – a violation of Hippocratic Oath – then the medical profession as a whole must assume responsibility for alleviating this harm.” This applies to breast reconstructive surgery, so why not fertility preservation as well?
Disputes Over Reproductive Material: Reproductive material, by law, is deemed “property” and it is the property of the people who make up its genetic material. In the case of minors, since the reproductive material is technically theirs, parents should not be able to make decisions about using, destroying or donating that material before the child turns 18, and can legally assume sole ownership over their “property.” Furthermore, should parents have the legal option of using their child’s posthumous reproductive material or should it immediately be donated to science or destroyed?
To learn more about ethical issues oncofertility providers face and potential ways to mitigate, prevent or resolve them, please read, “Addressing the Most Frequently Asked Questions of a Bioethicist in an Oncofertility Setting.”