Mock Q: Removing sperm from crash victim

[Guest Lactic Folly]

A man is brought into the emergency room, seriously injured from a car crash. Despite the team's best efforts, he passes away. The man's widow requests that you extract sperm from his body so that she will be able to have children by him (they currently do not have any). How do you respond?

[Guest coastal79]

Why wouldn't you do this?

[Guest Lactic Folly]

-victim's wishes not known

-family dynamics could change, and it might not seem as appropriate later on..?

I found this quite an ambiguous scenario in terms of the ethics.

[Guest turtle]

while my initial thought to this might be "hey, what's the harm go ahead & take the sperm out - it's not going to hurt anyone and may in fact make someone's life better (notably the wife)", i think there is more to it than that.

 

As Lactic Folly pointed out, the man's wishes are not known; in other words, he has not consented to donate his sperm and potentially have a child. There seems to be a good analogy here to that of organ donation. Maybe someone can refresh my memory: if the man was to die of his injuries (without becoming well enough in the meantime to ask him directly) and had never signed an organ donation card or anything like that, would his wife have the right to consent to have his organs donated on his behalf? And even if she did, would that still hold for his sperm, particularly since it would be difficult to untangle her decisions from her role as his proxy decision-maker (whereby she is supposed to act according to what he would have wanted) and her own self-interest (of having his child). And as for family dynamics, I guess it could go either way. It could create a very special bond between the mother and the child, but I can also see where it could add some difficult elements to the relationship too. That's not to say that in the end I wouldn't do it; just that there are more issues to consider than in that first sentence up there.

 

Slightly off topic, but definitely related: has anyone seen the movie 21 Grams? In it, Sean Penn's character is dying - he is on the waiting list for a heart transplant but it is taking a long time and he has a high likelyhood of dying in the meantime. His wife is understandably very upset about this and wants to have a child by him. They don't have a very good relationship and he doesn't seem to want a child, but in the end she basically pressures him into going & freezing some sperm so that she can do IVF and try to have a baby after he dies. But, he gets the transplant & doesn't end up dying. Without going into all the details of the movie, they end up breaking up and when she leaves she tells him she's going to go ahead & have his baby anyway, even though he doesn't want one, because the sperm is there & he's already signed the papers...

 

(Good movie, by the way, in case you haven't seen it.)

 

turtle

[Guest coastal79]

21 grams is definitely on my "to see" list.

 

I agree that in this situation it is difficult to determine whether the wife is acting as a responsible proxy (ie what her husband would have wanted) or for selfish reasons. From a practical point of view, unless you had incontrovertible evidence that the man did not want to have a child at any point in his life (difficult) I don't see how you could refuse his wife, who is his proxy. Since this would be a time sensitive issue, I'd just do it.

 

And as for family dynamics, I guess it could go either way. It could create a very special bond between the mother and the child, but I can also see where it could add some difficult elements to the relationship too.

 

Sure, but that's not an ethical issue. It is a practical issue that could be discussed with the wife, however, ultimately the decision should be left up to her.

 

Cheers

[Guest mying]

Trivial point as fodder for this question: They do it to badly injured racehorses all the time, but usually while the animal is still alive.

 

I knew a guy whose job it was to collect the sperm from the injured racehorse before they euthanized the horse.

[Guest noncestvrai]

I just wanted to mention that 21 grams is a great movie, one of the best of the year. Naomi Watts is hot.

 

noncestvrai

[Guest studentz]

I know, this thread was from a while ago, but I just read this story on the Globe and Mail's site...it's pretty crazy!

 

 

The unexpectant father

 

Thursday, February 24, 2005 Updated at 1:15 PM EST

 

Associated Press

Advertisement

 

Chicago — A U.S. appeals court has ruled that a man can press a claim for emotional distress after learning that a former lover had used his sperm to have a baby.

 

He cannot claim theft, however, the ruling said Wednesday, because the sperm were the woman's to keep.

 

The ruling by the Illinois Appellate Court sends Dr. Richard Phillips's distress case back to trial court.

 

Dr. Phillips accuses Dr. Sharon Irons of a “calculated, profound personal betrayal” after their affair six years ago, saying that she secretly kept semen after engaging in oral sex then used it to get pregnant.

 

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He said he did not find out about the child for nearly two years, when Dr. Irons filed a paternity lawsuit. DNA tests confirmed that Dr. Phillips was the father, the court papers state.

 

Dr. Phillips was ordered to pay about $800 a month in child support, said Dr. Irons's lawyer, Enrico Mirabelli.

 

Dr. Phillips sued Dr. Irons, contending that he has had trouble sleeping and eating and has been haunted by “feelings of being trapped in a nightmare,” court papers state.

 

Dr. Irons responded that her alleged actions were not “truly extreme and outrageous” and that Dr. Phillips' pain was not bad enough to merit a lawsuit. The circuit court agreed and dismissed Dr. Phillips's lawsuit in 2003.

 

The higher court ruled, however, that if Dr. Phillips's story is true, Dr. Irons “deceitfully engaged in sexual acts, which no reasonable person would expect could result in pregnancy, to use plaintiff's sperm in an unorthodox, unanticipated manner yielding extreme consequences.”

 

The judges backed the lower court decision to dismiss the fraud and theft claims, agreeing with Dr. Irons that she did not steal the sperm.

 

“She asserts that when plaintiff 'delivered' his sperm, it was a gift – an absolute and irrevocable transfer of title to property from a donor to a donee,” the decision said. “There was no agreement that the original deposit would be returned upon request.”

 

Dr. Phillips is representing himself in the case. He could not be reached for comment Thursday.

 

“There's a five-year-old child here,” Mr. Mirabelli said. “Imagine how a child feels when your father says he feels emotionally damaged by your birth.”

www.theglobeandmail.com/servlet/story/RTGAM.20050224.wsper0224/BNStory/International/

[Guest UWOMED2005]

Removing sperm from a crash victim?

 

WOW - you guys are coming up with the CRAZIEST scenarios. Seriously. These are ones I'm very glad I never had as a medical student. . . or as a residency applicant.

 

By the way, I'm not saying this isn't an interesting question to debate. Just that I wouldn't worry about this being asked in an interview.

 

And to be completely, honest - hope I never have in my career!!

 

My answer after 4 years of medical training: consult the medical ethics team.

 

I noticed there is another thread debating how to answer "Why do you want to be a doctor?" THAT is a question you WILL be asked, pretty much guaranteed, in any interview.

[Guest fierysweet]

Poor, pooooor Dr. Phillips (said with utmost sarcasm). While he was going around spreading his seeds, he didn’t realize that he was LITERALLY spreading his seeds. I actually can’t believe he has the gall to sue, because poor him, he’s having nightmares. He shoulda thought about this before he decided to engage in sexual relations with Dr. Irons. I think that once a man decides to have sex with any given woman, he has to assume the risk that this woman may get pregnant and that he will have no say whatsoever in whether or not she’ll keep the baby … or whether or not she’ll get pregnant for that matter. He can only use a condom and hope for the best. This is actually really funny. He “delivered” his sperm to her as a “gift” and “There was no agreement that the original deposit would be returned upon request.” Hehehe :rollin . I find that quite hilarious. Yep, if you’re gonna exercise your right to spread your seed, well pregnancy just comes with the territory.

 

Regarding the crash victim, I’m also thinking along the argument for organ donation. If the wife is legally allowed to give consent for this, then she can also remove his sperm. Whether or not he would’ve wanted a child would in that case would be irrelevant from a legal standpoint. After all, he’s dead and she IS his wife. I would think that if he knew he was going to be leaving her, he would have at least wanted her to have her wish (for a child or whatever else). Denying his wife a child because he doesn’t want offspring even if he’s dead is what seems perplexing and selfish to me. The wife’s desire to have a child, actually, any person’s desire to have a child, is not, in my opinion, selfish. I think it’s inherent and instinctual for most (yes, not all. There are exceptions) people, even if there may be some underlying selfish reasons. I find it cruel to deny your wife a child even after you’re dead!

[Guest ploughboy]

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I can't believe I'm replying to this crazy thread...

 

fierysweet - my favourite line from the judgement was the bit about "absolute and irrevocable transfer of title to property". I also liked the bit about returning the deposit upon request. I'm sure the judges had fun writing their decision.

 

However, I do think you're being a bit hard on Dr. Phillips. Given the nature of the act which apparently led to the conception of their child, I don't think he should have had any reason to suspect that Dr. Irons would become pregnant by him. Launching a lawsuit was a bit of an extreme reaction on his part, but so too were Dr. Irons' initial (alleged) actions. Both doctors seem a little bit nutty, if you ask me.

 

Getting back on topic... In response to the original question, and having had the benefit of reading everybody else's answers, I'd probably reply that I can see why she would make the request. She's just lost somebody very close to her, and it's understandable that she would want to bear her husband's child -- even more so now, as their child will be a legacy of him now that he's gone.

 

However...it was the husband who was my patient, not her. Even though he's dead I need to take his wishes into account. Maybe the reason the two of them had no children was that he very emphatically didn't want to have kids for what he thought were valid reasons. Who knows, maybe Huntingdon's or something like it runs in his family, and his view was that he couldn't in good conscience risk passing that genetic legacy on to his children.

 

Then I'd go on to say that although there are lots of decisions that have to be made in a split-second in an ER, this isn't one of them. It's not like she has to be impregnated then and there. Do the extraction, put the sperm on ice in escrow, and consult with the ethical/legal folks.

 

Oh, regarding mying's friend... I resisted telling this story last year when this thread was originally started, but since it's been revived I can't help myself. Must resist...must resist...aw nuts...

 

I actually interviewed for the job that mying's friend got. The interview went really well, and at the end of it my interviewer offered me the job for $15,000/year. I thought it over and told him I'd take the job, but I'd need a few weeks to come up with the fifteen grand...

 

(ba-da-da-BOOM!)

 

pb

 

 

 

 

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[Guest ploughboy]

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And just in case anybody was lying awake at night wondering how the case turned out, here's your answer...

 

       

Court denies woman right to use dead husband's sperm

Last Updated Fri, 27 May 2005 11:12:43 EDT

CBC News

 

CANBERRA - An Australian woman has lost a Supreme Court battle to have her dead husband's baby.

 

The 36-year-old woman's husband died in a car accident in 1998.

 

At that time, she successfully applied to the court to have sperm removed from his body. Her plan was to try to get pregnant by in vitro fertilization.

 

But the courts changed tack on Friday ruling the law did not allow for the procedure.

 

Justice Kim Hargrave said the procedure could not go ahead because the husband did not give his written consent before he died.

 

"It should not be assumed that such consent would necessarily have been forthcoming if the matter had been considered by the late husband," the judge said.

 

Hargrave said despite the ethical considerations raised by the case, the court was bound to apply the law as it stood, with any changes to the law to be made by Parliament.

 

With files from the Australian Broadcasting Corporation

 

 

From: http://www.cbc.ca/story/world/national/2005/05/27/australia-sperm050527.html

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[Guest rolloverbethoven]

If the patient was still alive, in the ER, with that severe trauma , his wife can not even save his sperm if he doesn't have the following three things:

1) self-awareness

2)rationality

3)autonomy

 

By the Warren and Fletcher theory .

 

But ,he is dead ! That means he has none of that.

No informed consent has been made, it is obvious that his wife is not allowed to save his sperm.

[katerade]

another story on this issue:

 

Dead Israeli soldier to reproduce

 

ARON HELLER

 

Associated Press

 

JERUSALEM — In a precedent-setting decision, an Israeli court has ruled that a dead soldier's family can have his sperm impregnated into the body of a woman he never met.

 

Keivan Cohen, 20, was shot dead in 2002 by a Palestinian sniper in the Gaza Strip. He was single and left no will, but at the urging of his parents, a sample of his sperm was taken two hours after his death and has been stored in a hospital since.

 

When the family tried to gain access to the sperm, however, the hospital refused, on the ground that only a spouse could make such a request. Arguing that their son yearned to raise a family, his parents challenged that decision in court. And on Jan. 15, after a four-year legal battle, a Tel Aviv court granted the family's wish and ruled that the sperm could be injected into a woman selected by Mr. Cohen's family.

 

The ruling also ordered the Ministry of Interior to register any children born as a result of the insemination as children of the deceased.

 

“On the one hand I'm terribly sad that I don't have my boy; it's a terrible loss,” Rachel Cohen said in an interview in Monday's Chicago Tribune. “But I'm also happy that I succeeded in carrying out my son's will.”

 

Ms. Cohen did not return phone calls from Associated Press.

 

Irit Rosenblum, a family-rights advocate who represented the Cohen family, said the ruling was significant because it set a precedent for those seeking to continue bloodlines after death.

 

At the trial, Ms. Rosenblum presented testimony, including video recordings, in which Mr. Cohen expressed his desire to have children.

 

“He always said he wanted children,” she told AP. “But there were no regulations in the law that deals with using sperm from dead people.”

 

Ms. Rosenblum said soldiers increasingly have been leaving either sperm samples or explicit instructions on post-mortem extraction before heading to battle.

 

She said she knew of more than 100 cases of Israeli soldiers who, before last summer's war with Lebanese guerillas, asked to have their sperm saved if they were killed. American soldiers have also begun donating sperm before heading to Iraq, she said.

 

“I think it is a human revolution,” she said. “Ten years ago, who would believe that a human being can continue after he has died. I think it is great for humanity.”

 

Ms. Rosenblum said the woman who is to act as surrogate mother has asked to remain anonymous.

 

“She's like family to us,” Rachel Cohen said. “Cruel and good fate brought us together.”

[wanttobedoc]

Katerade,

I was just going to post the Cohen case....I read about it a couple of weeks ago too.

Unless the patient leaves written instructions about wanting to become a father or at the very least a sperm donor, I think this is an extreme violation of one's autonomy...

If you want to be an organ donor then you have written consent for this so that when you die the doctors know if they can harvest them or not to based on your wishes. I would think, as some other posters have suggested that sperm donation would be along the same lines as this....

It just seems wrong, but I suppose in the Cohen case it made the parents very happy to have a piece of their son back by getting a grandchild out of him and some anonymous women they picked out. I find it weird that women would be lining up to volunteer for this...I read that 200 or so competed to be the mom.

[katerade]

i'm not surprised, considering the high regard that israeli's hold their soldiers in. i'm not sure if the same result would have occurred in canada (in the courts i mean). the courts here have shot similar cases down.

[Jochi1543]

I don't understand why they wouldn't let the family have it if the guy had no spouse. I mean, they'd be able to make any other major decision for him if he were incapable of doing it, but why not in this particular case?

[Kuantum]

I think this really opens a wackload of issues. When a person dies, does their body become property that a family can do whatever with. Are certain rights expected to be upheld if there wasn't any instructions given before time of decease, and is the whole idea of obtaining sperm of the dead and impregnating other women something that is morally right?

 

I know if there are instructions given it seems okay, but to me, there seems like there is something weird about it. It may just be me, however, my philosophy prof once described an ethical "yuck factor" when we discuss cloning. I think of this when I think of the idea of obtaining sperm from the deceased, fertilizing an ovum, and then placing it inside the uterus of a live woman.

[wanttobedoc]

/QUOTE]I know if there are instructions given it seems okay, but to me, there seems like there is something weird about it. It may just be me, however, my philosophy prof once described an ethical "yuck factor" when we discuss cloning. I think of this when I think of the idea of obtaining sperm from the deceased, fertilizing an ovum, and then placing it inside the uterus of a live woman.

 

I totally agree that the "Eeewhhhh" factor is huge and gives me the hibby gibbies. I know that is not medical terminology, but I think sometimes you have to go with your gut instincts, and it seems all wrong to me.

[katerade]

ok well then how about the fact that a woman give her deceased husbands organs away? if she has the power of attorney over his body, why cant she use his sperm if someone else can use his kidney?

[wanttobedoc]

ok well then how about the fact that a woman give her deceased husbands organs away? if she has the power of attorney over his body, why cant she use his sperm if someone else can use his kidney?

I was more referring to the Cohen case which is the parents not his wife. It is always more "neat and tidy" when people have legal documents/living wills to state what the do and do not want done to their body once they die.

[Smurfette]

ok well then how about the fact that a woman give her deceased husbands organs away? if she has the power of attorney over his body, why cant she use his sperm if someone else can use his kidney?

 

Well, she's expected to make the decision about the kidneys on his behalf because it is supposed that she is the best person to understand what his wishes would have been. The problem with the sperm is that her decision will be severely biased by what SHE wants and not what HE would have wanted. Therefore, her personal interests in the case would conflict and limit her ability to make a decision that on his behalf.

[eise]

First off, I think this is sick!

 

Katerade,

I read that 200 or so competed to be the mom.

 

That's probably because many isreali soldiers are super cute

 

But I don't get it! the guy's not alive to take care of the child. The parents are going to take care of it? Isn't that a conflict of interest? When a parent decides their child's kidney should be donated, it is not to them (or we should hope not!)

 

*hayley.

[eise]

I read that 200 or so competed to be the mom.

 

New Fox reality tv show: Surrogate!

The last woman standing gets to be the mom of a dead stranger's baby! Coming soon!

[TimmyMax]

Hey,

 

New Fox reality tv show: Surrogate!

The last woman standing gets to be the mom of a dead stranger's baby! Coming soon!

Sweet! Will it be on Sunday nights right before 'The Apprentice'?!? I'd definitely watch that dribble! Oh wait, there's already 'Flavor of Love 2', except that instead of competing to be the mom of a dead stranger's baby, they're competing to be the mom of a washed-up, has-been rapper's baby!

Regardless, it would definitely help those long minutes between pages on call go by faster!