Ethical and Psychological Considerations for Posthumous-Assisted Reproduction for Adolescents and Young Adults With Poor Cancer Prognosis in the Context of Grief

Abstract

Objective:

Families or loved ones of adolescents and young adults (AYA) with a poor cancer prognosis who preserved fertility and did not survive treatment may choose to pursue posthumous-assisted reproduction (PAR; i.e., use of preserved reproductive material for future family-building attempts). Decisions about PAR may be occurring in the context of grief and bereavement, which is associated with ethical and psychological considerations because grief can complicate a person’s capacity for informed decision-making.

Method:

Through the use of a five-step ethical decision-making model, the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct, and a blended case example, the ethical and psychological considerations for families of AYA with poor prognosis who pursue PAR are discussed with an ethical analysis.

Results:

Ethical and psychological considerations included assessing the potential for harm to involved parties, navigating PAR decision-making with responsibility and honesty, examining the accessibility of PAR, and considering informed consent/assent and autonomy.

Conclusions:

Clinical recommendations for supporting families and loved ones exploring PAR in the context of grief were discussed, with considerations for improving clinicians’ comfort and competence with PAR, incorporating grief into informed consent conversations, standardizing conversations about PAR, and promoting an interdisciplinary approach to PAR-related decisions.

Implications for Impact Statement

Families or partners who have lost their adolescent or young adult loved one to cancer may wish to pursue posthumous-assisted reproduction (PAR; i.e., using the deceased’s reproductive material for future family-building attempts). Families and partners may be experiencing grief when making decisions about PAR, which can raise ethical and psychological concerns. Pediatric psychologists are uniquely positioned to support surviving loved ones pursuing PAR in the context of grief to educate on the ways that grief can complicate decision-making processes and offer mental health support, while also respecting the autonomy of decision-makers.