{"id":3256,"date":"2017-11-15T10:58:50","date_gmt":"2017-11-15T09:58:50","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=3256"},"modified":"2017-12-04T17:02:23","modified_gmt":"2017-12-04T16:02:23","slug":"ethics-of-fertility-preservation-for-prepubertal-children-should-clinicians-offer-procedures-where-efficacy-is-largely-unproven","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2017\/11\/15\/ethics-of-fertility-preservation-for-prepubertal-children-should-clinicians-offer-procedures-where-efficacy-is-largely-unproven\/","title":{"rendered":"Ethics of Fertility Preservation for Prepubertal Children: Should Clinicians Offer Procedures Where Efficacy is Largely Unproven?"},"content":{"rendered":"<p><em><strong>Guest Post:\u00a0<span class=\"name\">Rosalind J McDougall,\u00a0<\/span><span class=\"name\">Lynn Gillam,\u00a0<\/span><span class=\"name\">Clare Delany,\u00a0<\/span><span class=\"name\">Yasmin Jayasinghe<br \/>\nArticle:\u00a0<a href=\"http:\/\/jme.bmj.com\/content\/early\/2017\/10\/27\/medethics-2016-104042\">Ethics of fertility preservation for prepubertal children: should clinicians offer procedures where efficacy is largely unproven?<\/a><\/span><\/strong><\/em><\/p>\n<p><em>Should we offer a procedure with so little evidence? <\/em><\/p>\n<p><em>Isn\u2019t it burdening a sick child without real justification?<\/em><\/p>\n<p><em>But it\u2019s often low risk &#8211; if we don\u2019t offer, are we depriving the child of a chance of becoming a genetic parent when they grow up?<\/em><\/p>\n<p>These were the kinds of questions that doctors brought to our clinical ethics service.\u00a0 They wanted ethical advice about offering surgical procedures for young children with cancer, aimed at preserving fertility.\u00a0 This is an area of rapidly developing science, but there is currently little evidence that the fertility preservation process works for very young patients.<\/p>\n<p>Cancer treatment can affect fertility, including in paediatric patients.\u00a0 The impact on fertility varies, depending on the specific treatment and the individual patient.\u00a0 For adult and adolescent patients, there are well-established fertility preservation strategies (such as freezing sperm and ova).\u00a0 Many babies have been born following these types of fertility preservation.<\/p>\n<p>The situation is different for patients who have not yet reached puberty.\u00a0 They do not have mature sperm or ova to collect and store.\u00a0 The main strategy available for young children is surgically removing and freezing ovarian or testicular tissue, for later re-implantation.\u00a0 For this age group, there is only very limited evidence that this process can be successful in producing a baby.\u00a0 Essentially, the patient\u2019s tissue would be removed and stored in the expectation that science will continue to progress as he or she grows up.\u00a0 When we first began discussing this issue with clinicians, there was promising research about utilising prepubertal tissue but no live births reported.\u00a0 So the key question was whether a child should be exposed to the risks and burdens of a surgical procedure, for this highly speculative future benefit.<\/p>\n<p><!--more--><\/p>\n<p>Over several years of discussing this issue with clinicians, we have come to the view that offering fertility preservation procedures for prepubertal patients is sometimes ethically justified.\u00a0 Although the benefit available is small, the degree of burden is also low in many cases.<\/p>\n<p>The procedure is beneficial in the sense that it provides a possible pathway to becoming a genetic parent in the future.\u00a0 The chance may be remote, but it is likely greater than if the procedure was not undertaken.\u00a0\u00a0 While philosophers question the importance of genetic connection, there is a substantial body of empirical work indicating that fertility is highly valued by many people.\u00a0 So the key benefit of attempting fertility preservation is that it increases the child\u2019s chance of genetic parenthood in the future, which he or she is likely to value.<\/p>\n<p>However, there are many important ethical concerns about potential burdens to the child associated with attempting fertility preservation: burdens at the time of surgery and into the future.\u00a0 These include the surgical risks of the procedure, potentially delaying the child\u2019s cancer treatment, and creating false hope for families.\u00a0 Many of the potential burdens can be minimised with good organisational processes for informed consent and timely surgery.\u00a0 There are additional burdens that may apply to specific patients depending on their medical situation.\u00a0 However, for many children, the burdens of the procedure are low.<\/p>\n<p>Each child\u2019s situation needs to be considered individually.\u00a0 An ethical assessment of the benefits and burdens <em>for that specific child<\/em> needs to be conducted each time fertility preservation procedures are being considered.\u00a0 We have designed an ethics framework and process to ensure that this type of ethical reflection is now built into the care pathway for each individual child in this situation at our hospital.<\/p>\n<p>Fertility preservation is area of science that continues to evolve quickly.\u00a0 During the writing of our paper, the first birth using prepubertal tissue was reported [www.bbc.com\/news\/health-38312995].\u00a0 The ethics framework that we propose for prepubertal fertility preservation will likely continue to develop as research \u2013 both scientific and bioethical \u2013 progresses.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Guest Post:\u00a0Rosalind J McDougall,\u00a0Lynn Gillam,\u00a0Clare Delany,\u00a0Yasmin Jayasinghe Article:\u00a0Ethics of fertility preservation for prepubertal children: should clinicians offer procedures where efficacy is largely unproven? Should we offer a procedure with so little evidence? Isn\u2019t it burdening a sick child without real justification? But it\u2019s often low risk &#8211; if we don\u2019t offer, are we depriving the [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2017\/11\/15\/ethics-of-fertility-preservation-for-prepubertal-children-should-clinicians-offer-procedures-where-efficacy-is-largely-unproven\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[968,2153,443,2022],"tags":[],"class_list":["post-3256","post","type-post","status-publish","format-standard","hentry","category-clinical-ethics","category-guest-post","category-jme","category-reproduction"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Ethics of Fertility Preservation for Prepubertal Children: Should Clinicians Offer Procedures Where Efficacy is Largely Unproven? - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2017\/11\/15\/ethics-of-fertility-preservation-for-prepubertal-children-should-clinicians-offer-procedures-where-efficacy-is-largely-unproven\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Ethics of Fertility Preservation for Prepubertal Children: Should Clinicians Offer Procedures Where Efficacy is Largely Unproven? - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"Guest Post:\u00a0Rosalind J McDougall,\u00a0Lynn Gillam,\u00a0Clare Delany,\u00a0Yasmin Jayasinghe Article:\u00a0Ethics of fertility preservation for prepubertal children: should clinicians offer procedures where efficacy is largely unproven? Should we offer a procedure with so little evidence? Isn\u2019t it burdening a sick child without real justification? 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