Carl Cohen

Procreation after death or mental incompetence: medical advance or technology gone awry?

OBJECTIVE To review our experience with semen retrieval in men who are incompetent or dead and to formulate general medical, legal, and ethical guidelines for practitioners. DESIGN Case series and literature review. SETTING Academic. PATIENT(S) Seven incompetent or neurologically dead individuals in whom sperm retrieval was requested. INTERVENTION(S) Electroejaculation. RESULT(S) Seminal emission was induced in the two men who underwent electroejaculation. Sperm suitable for cryopreservation was obtained in one of these men. Review of the legal and ethical implications of such procedures led to development of general guidelines for determining whether gamete retrieval should be performed when requested. Issues of procreational autonomy, consideration of the decedents wishes, and assurance of the well-being of any new life created were considered most strongly in the formation of these guidelines. CONCLUSION(S) Although the retrieval of sperm from deceased or incompetent individuals may be achieved readily, it is incumbent upon the practitioner to consider the legal and moral implications of these procedures before proceeding.

Animal experimentation defended

From my colleagues at the University of Michigan I bring cordial greetings to our friends and hosts in ARTEM and the Istituto di Ricerche Farmacologiche ‘Mario Negri’, and associated organizations. The intellectual objectives, and the methods of humane inquiry, for researchers on all continents are in essential harmony; I take this opportunity to express satisfaction in our mutual support. My remarks regarding the use of animals as subjects in biomedical experiments are presented under four headings.

Militant Morality: Civil Disobedience and Bioethics

Seven essays in this issue of the Hastings Center Report defend civil disobedience as a legitimate form of protest against terrible injustices: legalized abortion (G. Leber); abridgement of womens reproductive rights (S. Davis); government policy toward persons with AIDS (H. Spiers and A. Novick); abuse of the rights of animals (S. Siegel, C. Jackson, and P. Singer). An eighth essay, by B. Nathanson, examines the motivations of Operation Rescue, an organization that uses civil disobedience to protest legalized abortion. Cohen explores the problems that these authors and others encounter in trying to justify deliberately breaking the law in public conscientious protest. He examines three forms of protest -- direct civil disobedience, indirect civil disobedience, and direct action -- and three justifications -- higher-law, utilitarian, and only possible means. Cohen concludes that, in a democracy, objective justification of civil disobedience is very difficult.

What Is the Difference between an HIV and a CBC

Two commentaries discuss a case in which an HIV antibody test was ordered for diagnostic purposes for a woman presenting with confusing symptoms that included generalized weakness and with a history of blood transfusions. The commentators consider whether the patient should have been told, and given consent, before having the test, and whether the patient should be informed of her HIV antibody status once it is known. One author argues that, because of the greater risk of adverse consequences from this procedure than from other blood tests, the patient should actively participate in the decision making process, whereas the opposing view contends that specific consent is not necessary because the tests for AIDS are not different from nonintrusive tests for other conditions.

Postmortem Sperm Retrieval: Ethical, Legal, and Logistical Considerations

Introduction: Sperm retrieved following the death of a reproductively aged male can be cryopreserved and subsequently used for posthumous reproduction. Although requests for postmortem sperm retrieval (PMSR) are uncommon, the procedure has been performed with increasing frequency worldwide in recent decades. Legislation related to PMSR is highly variable, or completely nonexistent, forcing physicians and hospitals to consider a myriad of legal, ethical, and logistical questions whenever PMSR is requested. In this chapter, we summarize these considerations and review relevant sperm procurement procedures to provide a framework for hospitals to consider when developing institutional policies for PMSR.