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Societal and Ethical Issues
Title:The disclosure decision: Concerns ad issues of parents of children conceived through donor insemination
Author: R.Nachtigall et al.
Address: San Francisco, California
Source: American Journal of Obstetrics and Gynecology 178: 1165-1170 (June)1998
Summary: The goal of this study was to identify the concerns and issues that may have influenced donor insemination parents' decision on disclosure and to examine the relationship between categories of concern and the parents' gender and position on disclosure. A questionnaire was mailed to 184 couples who had conceived through donor insemination. The resulting 42% response rate included 70 men and 86 women. Of these respondents, 30% stated that they would disclose and 16 % were undecided and 54% indicated that they would not disclose this information about their child's conception. Only 1 in 65 couples reported opposite disclosure intentions. Among those who have indicated that they will disclose this information, 70% commented about honesty and only 2% were concerned with confidentiality. Of non disclosers, 74% were concerned with confidentiality and 1% commented on honesty. Of the group that remained undecided, 40% were concerned about confidentiality and 16% honesty. Thus, the only significant relationship was between confidentiality and honesty (x2 =99.9, p less than 0.05). The authors noted, "there was no association between disclosure position or gender and expressed concerns about parenting, children and family relations". Honesty and confidentiality were the main issues determining whether or not to disclose that an individuals child is the product of donor insemination. It is important to note that 52% of the targeted study population neglected to return a questionnaire. These nonparticipants may indeed represent a population of nondisclosures. This may indicate a selection bias.
Note* Klock and Maier and others have published studies indicating that some donor insemination have regretted their decision to disclose this information to others.
Title:Intergenerational gamete donation: Ethical and societal implications
Author: L.Marshall
Address: Seattle, Washington
Source: American Journal of Obstetrics and Gynecology 178: 1165-1170 (June)1998
Summary: Daughter- to -mother and niece - to - aunt oocyte donation and father - to -son sperm donation were reviewed as representative as well as individual case studies.Ethical evaluation included viewing the cases with regard to: respect for autonomy of the recipient couple and the gamete donor, and the potential risks to the recipient couple, gamete donor, offspring, and other family members. Manipulation and coercion appeared to be the most obvious ethical risk areas when considering intergenerational gamete donation. It was recommended that the factors to be evaluated are: the ability to make an autonomous decision, age and maturity, financial dependence on the recipient couple, physical and emotional distance between involved parties, and the specifics of family dynamics . An interesting potential risk to other family members was uncovered in this discussion concerning the role of the ex husband when he was made aware that his genetic material was involved in the daughter- to -mother oocyte exchange. The mother was in a second marriage and the daughter was from the first marriage. Societal issues are raised because these arrangements create new genetic relationships. It is argued that complicated blended family relationships already exist in American society and that these few situations add little complexity to our current societal setting. Final recommendations pointed out that these three cases were not representative of all cases and that each and every case needs review on an individual case basis. The author suggested that although current guidelines for gamete donation do not require psychologic counseling, that such counseling may play a vital role in gathering the information necessary to help the ART program act in the best interest of all parties. Adequate time to identify, discuss and clarify issues is identified as an important component to ensure the best outcome for all involved. It was noted that counseling has become an important component in assisted reproduction programs and that some larger programs have established their own ethic advisory boards to provide case review, education and policy development as it pertains to reproductive issues.
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