Donor Conception Disclosure: Directive or Non-Directive Counselling?

Abstract

It is widely agreed among health professionals that couples using donor insemination should be offered counselling on the topic of donor conception disclosure. However, it is clear from the literature that there has long been a lack of agreement about which counselling approach should be used in this case: a directive or a non-directive approach. In this paper we investigate which approach is ethically justifiable by balancing the two underlying principles of autonomy (non-directive approach) and beneficence (directive approach). To overrule one principle in favour of another, six conditions should be fulfilled. We analyse the arguments in favour of the beneficence principle, and consequently, a directive approach. This analysis shows that two conditions are not met; the principle of autonomy should not be overridden. Therefore, at this moment, a directive counselling approach on donor conception disclosure cannot be ethically justified.

Oocyte donation disclosure decisions: a longitudinal follow-up at middle childhood

“…For the past several decades, there has been a strong global trend toward advocating disclosure about conceptual origins to children conceived using gamete donations (oocyte, sperm, embryo) and/or surrogacy (Daniels, 2007;Greenfeld, 2008;McGee, Brakman, & Gurmankin, 2001;Sabatello, 2015). Although practice guidelines in the US have advocated for disclosure since 2004 (Ethics Committee of the American Society for Reproductive Medicine, 2004Medicine, , 2018, there remains a lack of consensus regarding counseling families about disclosure and, in particular, whether directive counseling (favoring openness) for OD and other gamete donation parents is ethically or morally justified (de Melo-Martín, 2014Raes, Ravelingien, & Pennings, 2016). In fact, a 2017 editorial advocating a neutral position to parents about disclosure to donor conceived children (Pennings, 2017) garnered immediate worldwide responses that refuted the notion of secrecy (Crawshaw et al, 2017;Golombok, 2017;Pasch, Benward, Scheib, & Woodward, 2017).…”

Experiences of Misattributed Parentage Communities: Impacts of Discovering New Familial Kinships

“…44 People with an MPE may also feel a sense of betrayal by their raising parents who kept this secret from them. 45 Nothing has ever tested me as much as this journey. My relationships with my mother and father (who isn't my biological father) have suffered immensely.…”

Psychosocial Consequences of Disclosing Misattributed Paternity: A Narrative Review

“…Another important consideration for individuals with misattributed paternity and their children was medical history. Many scholars highlighted the relevance of having a complete medical history (Raes et al, 2016; Ravitsky, 2017; Wright et al, 2019); however, opposite views were present as well (Haimes, 2006). Without disclosure, incorrect medical decisions can be made (Ravitsky, 2017), including unnecessary medical interventions and dangerous unawareness of possible health risks (Raes et al, 2016).…”

“…Finally, individuals with misattributed paternity and DC individuals can differ in their health. While potential donors undergo prescribed genetic and health screenings (Raes et al, 2016), no such screenings occur for genetic fathers of misattributed paternity children. Admittedly, despite thorough screening for hereditary conditions, a rare genetic disorder may be overlooked in donor-assisted reproduction (Raes et al, 2016).…”

“…While potential donors undergo prescribed genetic and health screenings (Raes et al, 2016), no such screenings occur for genetic fathers of misattributed paternity children. Admittedly, despite thorough screening for hereditary conditions, a rare genetic disorder may be overlooked in donor-assisted reproduction (Raes et al, 2016). Overall, the misattributed paternity children are likely to have a higher risk of unknowingly inheriting a health condition than DC children and be disadvantaged in their health prospects due to incomplete medical history information.…”