The Ethical Challenges of Providing Fertility Care to Patients with Chronic Illness or Terminal Disease

Abstract

The field of fertility is rapidly evolving, bringing opportunities for improvement in our patients' quality of life as well as bringing new ethical dilemmas. As medical science continues to advance, significant numbers of the reproductive-aged population are living with chronic and/or terminal conditions but have reasonable odds of lengthy survival and wish to have children. Likewise, there are adolescents diagnosed with cancer who are increasingly expected to achieve an improved, if not normal, life expectancy after treatment. Oftentimes these children are told they must sacrifice their ability to later have genetically related offspring; however, technologies to preserve fertility are changing this prognosis. Patients with chronic infection are living longer, more normal lives and are increasingly seeking reproductive assistance. Moreover, there is an increasing number of patients' families desiring posthumous use of gametes, which also raises ethical and legal issues. This article discusses ethical principles of bioethics and then highlights specific ethical issues through four plausible cases that may be seen in a fertility practice providing medical care to patients with chronic illness or terminal disease. It concludes that prompt referral of patients to the reproductive endocrinologist, along with a multidisciplinary approach to care, provides increased chances of successful treatment of this group of patients.

Communication and ethical considerations for fertility preservation for patients with childhood, adolescent, and young adult cancer: recommendations from the PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group

“…Ethical issues regarding informed consent • Informed consent to procedures for fertility preservation in minors and young adults 5,64,67,69-97 • Safeguarding and protecting patients' best interests when making decisions about fertility preservation 67,71,72,76,78,[82][83][84][85][86][87][91][92][93][94][98][99][100][101][102][103][104][105][106][107] Ethical issues regarding communication • Communication between health-care providers and patients and their parents, caregivers, and partners 5,52,67,70,71,[73][74][75][76][77][78]81,[84][85][86]89,92,93,96,[98][99][100][105]…”

Oncofertility: Fertile Ground for Conflict Between Patient Autonomy and Medical Values

“…To make clinical decisions in the context of vexing ethical dilemmas, we should consider Beauchamp and Childress's four guiding principles of medical ethics: respect for autonomy, nonmaleficence, beneficence, and justice . However, the balance between patient autonomy and nonmaleficence can be difficult to achieve in cases of medically complicated patients when the intervention required for fertility preservation can be potentially life threatening.…”