4.3.3 Reproductive Health: Storage and Disposal of Gametes and Embryos
Josephine Johnston, LLB, MBHL
- To understand the ethical and legal issues that might arise when patients store and dispose of gametes and embryos that are obtained or created in the course of assisted reproduction.
This case continues from case 4.3.2, "Control and Use of Gametes and Embryos," in which a couple, Mara and Tony, used in vitro fertilization (IVF) technology and a sperm donor to create 10 embryos. Dr. Garcia's clinic froze eight of Mara and Tony's embryos and transferred the other two embryos to Mara, who became pregnant with twins. Two months after Mara and Tony's twins are born, researchers from the local university approach Dr. Garcia's clinic seeking embryos for use in stem cell research, which has been approved by the research ethics board. Dr. Garcia is currently storing several hundred frozen embryos in her clinic, of which eight belong to Mara and Tony.
- Should Dr. Garcia ask Mara and Tony to consider donating their eight frozen embryos to stem cell research? Should Dr. Garcia seek the consent of the sperm donor to donation of the embryos to stem cell research?
At the time he made the donation, the sperm donor agreed to the possibility that embryos created using his sperm might be donated to stem cell research, but Mara and Tony now do not agree to donate their embryos and instead choose to continue to keep their eight embryos in frozen storage. Three years later, Mara and Tony come to Dr. Garcia's office to discuss the options for disposing of their frozen embryos. Dr. Garcia's clinic still provides embryos to the local stem cell research effort, and also runs an embryo donation program. In addition, Dr. Garcia uses unwanted embryos to train new technicians and to practise using new equipment. Finally, she also thaws embryos and either gives them back to the patients or incinerates them in her laboratory.
- Assuming the sperm donor had agreed to the possibility of all these possible fates for any embryos created using his sperm at the time he made his donation, which of the options for embryo disposal is Dr. Garcia obliged to offer Mara and Tony?
Mara and Tony are interested in donating their embryos to other patients. Dr. Garcia has four couples who are seeking donated embryos. Mara and Tony ask whether they can choose which couple will receive their embryos.
- Should embryo donors be able to select who should receive their donated embryos?
It turns out that Mara and Tony cannot agree on what to do with their eight frozen embryos after all, so they pay for another three years' storage. During this time, they divorce. Mara then comes to see Dr. Garcia and asks to use these embryos for another pregnancy attempt.
- Should Dr. Garcia thaw and transfer any of the eight frozen embryos to Mara? Does Dr. Garcia need Tony's consent before she does so?
- Department of Justice Canada. Assisted human reproduction act, 2004 (c. 2). Available from: http://laws.justice.gc.ca/en/A-13.4/index.html.
- Assisted Human Reproduction (Section 8 Consent) Regulations, Canada Gazette, Vol. 141, No. 13, June 27, 2007. Available from: http://laws-lois.justice.gc.ca/eng/regulations/SOR-2007-137/page-1.html.
- Canadian Institutes of Health Research. Updated Guidelines for Human Pluripotent Stem Cell Research. Ottawa: Canadian Institutes of Health Research, 2007. Available from: http://www.pre.ethics.gc.ca/eng/policy-politique/initiatives/tcps2-eptc2/chapter12-chapitre12/#toc12-1f.
Further Reading and Resources
- Braude P, Muhammed S. Assisted conception and the law in the United Kingdom. British Medical Journal 2003; 327: 978-81.
- Ethics Committee of the American Society for Reproductive Medicine. Access to fertility treatment by gays, lesbians, and unmarried persons. Fertility and Sterility 2006; 86: 1333-5.
- Ethics Committee of the American Society for Reproductive Medicine. Informing offspring of their conception by gamete donation. Fertility and Sterility 2004; 81: 527-31.
- Ethics Committee of the American Society for Reproductive Medicine. Donating spare embryos for embryonic stem-cell research. Fertility and Sterility 2002; 78: 957-60.
- Health Canada. Assisted human reproduction website: http://www.hc-sc.gc.ca/hl-vs/reprod/index_e.html. (Includes information about any regulations made under the Act.)
- Health Canada. Assisted Human Reproduction Agency of Canada website: http://www.hc-sc.gc.ca/hl-vs/reprod/agenc/index_e.html.
- White A, Nisker J. The CMA Code of Ethics and the donation of fresh embryos for stem cell research. Canadian Medical Association Journal 2005; 173: 621-2.
- Draper H. Gametes, consent and points of no return. Human Fertility 2007; 10: 105-9.