Fertility Preservation in Cancer Patients: Ethical Considerations

Abstract

Ethical consideration has a strong history and is of prime importance in the field medicine. Starting from the birth of Western medical ethics, the Hippocratic Oath, to the modern framework set forth by the Principalist approach [1] which involves the consideration of four principles – autonomy, beneficence, non-malfeasance, and justice. These four principles are not rigid mandates. Rather, these principles are meant to provide a useful framework to help health care providers make decisions when reflecting on moral issues as they arise. Although these principles are useful for many medical encounters, certain situations may present conflict between two or more principles and ethical dilemmas may arise. The burgeoning field of reproductive medical technology is ripe with ethical dilemmas and suggests a need for on-going ethical analysis as the sensitive topics of human life and reproductive rights are addressed. One of the most recent medical advances in reproductive medicine, attracting ethical consideration, is the practice of fertility preservation in cancer patients. The reproductive technologies allowing fertility preservation in cancer patients were born out of a recognized need to address the reported psychological distressed caused by infertility [2–7] in the increasing population of cancer survivors with impaired fertility [8]. The ethical endorsement of the practice of offering fertility preservation to cancer patients stems from the ethical principle of autonomy, referring to self-government and free choice, which promotes the individual right to reproduce and beneficence, to do good to patients by relieving distress associated with infertility.

It was an endless series of bad news, good news – an emotional rollercoaster. The day the doctors told me my six year old daughter had cancer was the darkest day of my life. Then they told me her chances of survival were good but she would never have children and she may have other permanent damage like hearing loss and heart problems. I thought about how much having children meant to me, how being a mother was what I had dreamed of when I was a little girl. My little girl seemed to have the same dream. She mothered her dolls, mothered the cat, she liked to dress up in my high heels and purse and say she was going to the store to buy food for her baby dolls. Now she was going to be robbed of this experience. The good news was she was likely to survive but the bad news was she was never going to have the life we wanted for her and we thought she wanted for herself. I asked her doctor if there was anything we could do to prevent the sterility. He told me there was an experimental procedure we could consider where they froze some tissue from her ovaries. He said there were no guarantees and it was expensive and not likely to be covered by our insurance. I thought about it for a long time and weighed the pros and cons. If I didn’t do this procedure for her would she be angry at me when she was older? If I allowed her to have the procedure would the extra time and money be worth it? Would my daughter feel compelled to have a child because I had stored her tissue for her? Would this experimental procedure lead to a baby for her one day? I had a lot of questions but no answers. I asked the doctors if there was another parent I could talk to who was faced with the same decisions as me. I felt very alone, and even selfish when they told me that most parents were grateful if their child had a good survival prognosis and didn’t worry about fertility. I didn’t have a lot of time to make a decision either – they wanted to start treatment right away. I did some searching on the Internet and found a national organization. I started to read about how other parents were in the same quandary as me – I was not alone but most parents didn’t express their concerns to their child’s oncology team because they were waiting for the team to bring it up. In the end I decided to have my daughter’s ovarian tissue frozen. Was it the right thing to do? I don’t know and won’t know for a long time. But I thought about how we saved for college for her, so she would have that option. This seemed like another type of savings plan. Time will tell if I made the right decision.

Emma, Mother of Pediatric Cancer Survivor