Assisted reproduction and the posthumous child

Recently a married woman came to our institution, her husband was brain dead and they were going to disconnect him from the equipment that kept him alive. Her question was if they could extract the semen from him and freeze him.

Authorization was requested from the Clinic, whose ethics committee approved the procedure, and from CENATRA, which did not authorize it.

For the organization, the premise is the following: the surviving couple can give permission to use the organs of the deceased couple to transplant them to those who need it, but the gametes: semen and ovules, can only be obtained after signing the authorization of the subject to giving up these cells to the member of the couple who remains alive.

Ethically, this case raises striking ideas that were discussed in a very interesting ethics committee, but a question was on the minds of some of us: What goes on in the head of the person left behind?

In 2012, Harvard University carried out an investigation aimed at finding out what the opinion of the population between 18 and 75 years of age was regarding posthumous reproduction. The results of a sample of 1049 people gave the following results:

In the case of men, 47% supported it and 31.1% were against it, and in the case of women, 42% supported it and 35.9% were against it. The rest were undecided. It is important that 69.8% of those who supported it considered that prior consent should be required.

Assisted reproduction with its artificial inseminations, in vitro fertilization, and gamete donation opened up a range of opportunities for couples who normally would never have been able to have children. Thanks to this event, the opening to the different types of family also arose, among them, that of the woman or man who is a mother or father alone. Therefore, the fact that a widowed woman (in this particular case) wants to assume the maternity of a deceased husband’s son should not be surprising. It would only require of us an adaptation of some factors that were recognized when we accepted that a woman or man only has the same right as anyone to be a mother or father. The difference in this case is that both parents have agreed that living in these conditions is correct and viable for the one who survives.

From an emotional point of view, the death of a partner is one of the vital moments of stress and can be the origin of physical illnesses. It requires proper attention and cannot be seen as a process that simply has to be overcome. The implications of having a partner go beyond that person. They are linked to the idea and plan for the future of the one who remains alive. Not only dies the partner (or), dies the plan, the desire, tomorrow. At least that is how most of those who live that moment perceive it.

The grieving process has been described by specialists as a series of stages that the subject lives from denial to acceptance, going through hard times that can be included in other stages such as anger, negotiation, and depression.

When the couple dies, and the one that survives wishes to obtain their cells, we speak of emergency extractions. If we locate the patient who visited us at this moment of mourning, we can say that she is acting from denial when we assume that she is experiencing a refusal to let go, or in control, when what she wants is to preserve part of those plans for the future that she had. with the partner you chose. I repeat the expression that remains in who hears it: emergency. Even though we presume that she refuses to face death, we can also think that a rational part is reminding her that there is something to do. This is why, although there are stages of mourning, we must look at them not as a linear process, in which one stage must precede the other. The subject who lives a duel, lives the stages without order or concert, the only sure thing is the experience of pain, which cannot be measured or organized.

As mental health professionals, what kind of care should we have for a person who experiences such an event?

First of all, if it is possible to salvage cells, it must be done. But here yes, it is essential to consider the ethical fact of the couple’s permission and it must be in writing. In 1997, English Diane Blood obtained legal permission to use the semen of her husband, who was about to die of meningitis, to conceive their child. There was no signed authorization, only verbal, and although they gave him permission to do so in any country of the European Union except the United Kingdom, this case cannot be used as a precedent in the future. Mrs. Blood currently has two children conceived three years apart using the semen of her deceased husband, and she lives her life as a single mother.

More recent is the case of the Spanish Mariana González, who claimed the right to dispose of her husband’s gametes in Spain that had been cryopreserved in France. Her husband had cancer of the lymphatic system and froze her semen as a means of fertility preservation in 2013 while they were living in Paris. Assisted reproduction laws in France only allow its use by living infertile couples, so it was initially denied. The woman appealed and her case did create a precedent in France, since the consideration was that both had wanted to have children but the husband’s illness had prevented her from carrying out her project. For this reason, she was authorized to take her samples to Spain, where she would have to do so before the legal term of one year after the death of her husband expired, the maximum limit for this type of procedure in that country. Mrs. Blood had the time to close the process of her loss, since her authorization came two years after the death of her husband. Mrs. González had to speed it up due to the laws of her country. We will still have to see how her life turns out in the future since until the date of this article there was no information about whether the artificial insemination had been performed, which had to be done before July 10, 2016.

Taking the above considerations into account, we know that we can only support subjects who have written permission to use their partner’s cells.

When working with them, it would be essential to carry out a psychological evaluation that would give the person security that they are making the decision for themselves, not to please grandparents, relatives, inheritance succession needs, etc. It would be necessary to carry out a therapeutic follow-up to cope with the grief and the preparation to assume a family of mother or father and child or children, since parenting alone is not easy and requires a thoughtful and analyzed commitment.

“For this decision to be made in the best of conditions, it would be useful to give that person a mourning period of more than six months before using the cells, especially so that they can carry out an adequate study about the positive and negative implications. of being a father or mother without having the support of the couple.”

Psyd. Linda Jiménez Méndez

Take care of your health, take care of your body and always consult your specialist.