Dilemmas relating to the perimortem retrieval and posthumous use of sperm have featured in a number of recent BioNews articles. In Australia, a woman will be allowed to use her late partner's sperm - retrieved without his consent - to conceive a child (reported in BioNews 736). In the UK, a woman has commenced legal proceedings to be allowed to keep her deceased partner's sperm in storage for longer than the period for which he had given formal consent (reported in BioNews 734).
These cases show us how variable attitudes toward consent may be in different countries. On the basis of the examples above, we might assume that the UK is exceptionally punctilious in obtaining, and sticking to the letter of patients' consent. But in fact there is variability within the UK on these matters too. There have been several cases in the UK in which sperm has been retrieved from dead or dying men without their consent.
Consider this hypothetical situation. You are crossing the street one day, and are hit by a motorbike. You are rushed to hospital; medics do all they can but the prospect looks bleak. Your life is being sustained by machinery; your partner weeping by the bedside. You hover ethereally, as dying patients do, we are told, somewhere around the ceiling. You hear the doctor's solemn murmuring '... futile... we don't think... best interests... natural end... dignity'. You get the picture – they want to turn the machine off. Soon you will be gone forever.
But then – 'Wait!' you hear your tearful partner say. 'We always planned to have a baby together; this is our last chance. Take some of his sperm before you turn the machine off'.
Should you – the soon-to-be deceased – be concerned? The answer may depend on how squeamish you are. The process of sperm retrieval from comatose men involves the insertion of an electric probe into the rectum; current is applied rhythmically to stimulate ejaculation, which usually results in its emission into the bladder from where it can be retrieved through a catheter (a tube inserted in the opening of the penis and pushed through into the bladder). In your near-death state you might not experience any sensation, but nevertheless, you might prefer your dying moments to be free of such interventions. Alternatively, you might welcome the prospect of continuing your genetic line, especially given that your own prospect of making your mark on the world is quickly dwindling.
Only you can really answer that question - but you have no way of communicating your wishes to the doctors or to your partner. Should we err on the side of compassion for the grieving partner, or exercise caution before embarking on a series of invasive procedures during your dying moments? Women who wish to obtain their partners' sperm should also consider whether they would be equally happy to undergo egg retrieval in the same circumstances.
In fact a simpler, more basic way of preserving the reproductive potential of one's female partner is to leave the life support on, and attempt to reproduce in the old-fashioned way (through intercourse). Pregnancies have been successfully brought to term in comatose women. Would this be deemed acceptable?
In both cases, the patient's body is being entered for a specific purpose, in order to meet the reproductive wishes of a third party. If we accept one, I would suggest, we would have to accept the other.
In the UK, medical procedures can usually be undertaken only with the patient's consent. Despite this, in the UK, and elsewhere, medical professionals are being persuaded to harvest gametes even where the consent of the patient had not been obtained. Is sperm retrieval a justifiable exception to the protection that the law gives our bodies in other situations?
The treatment of other people's bodies – especially when they are dying, or unable to consent - is of extreme moral significance. People at the end of their life are exceptionally vulnerable. Their tissues and organs may be treated as commodities that are separable from the person; they may be transferred or sold. They may become the means by which others achieve their wishes.
We as members of the public need to think about whether these interventions are an acceptable part of the process of dying, and whether we want to loosen the legal restrictions that limit what can be done to us at our most vulnerable moments.