An Israeli family has received permission to extract and freeze the eggs of its 17-year-old daughter who died earlier this month in a car accident, according to the Israeli English-language website Haaretz.
Chen Aida Ayash died on Aug. 3, 10 days after she'd been struck by a car, at Kfar Sava's Meir Hospital. Her parents donated her organs and obtained a court order to remove and freeze Chen's eggs. They'd initially requested that the eggs be fertilized with donated sperm, but judges declined the petition until the family could prove that Chen had wanted to have children.
"Ethically, the important issue is not whether the woman would have wanted children," said Rosamond Rhodes, director of bioethics education at Mount Sinai School of Medicine in New York. "Regardless of the reproductive possibilities, she will not be around to have the child [or] children."
Instead, Rhodes said the critical issue is whether Chen would have wanted her biological children to come to life after she was dead.
"This question is rarely considered by anyone," said Rhodes. "People can have strong negative feelings about this possibility -- it can sound really yucky. And many people would not want others, including their own parents, to raise their biological child."
The court decision is the first of its kind in Israel, and possibly the world, to allow a family to extract a woman's ova after her death, but there are several known cases of families harvesting the sperm of dead male family members.
Despite the growing number of cases, medical ethicists remain unsettled with the idea of extracting eggs and semen after death.
"While organs of the dead can be used to save the life of another, using the gametes of a dead child to create another child creates a troubling precedent," said Laurie Zoloth, director of the Center for Bioethics, Science and Society at Northwestern University. "In a world in which thousands of children are lost and starving, the use of medical technology for this end raises other questions about the just use of shared resources.
"The fact that sperm has been used this way, for the same tragic reasons, is not an ethical justification," she said.
When doctors and families do decide to follow through with such decisions, several other weighty problems arise.
"Here, since the patient cannot give consent, doctors would need to be assured that a suitable substitute decision-maker is in place and can provide consent," said Judith F. Daar, professor of law at Whittier Law School in Costa Mesa, Calif. "Families must try to set aside their understandable desire to keep a part of their child and focus on what their child would have actually wanted.
"It strikes me as unlikely a minor child would have had the capacity and maturity to meaningfully assert an interest in motherhood, let alone motherhood after her death," said Daar.
As the counterpart to extracting sperm posthumously from men, Dr. Michael A. Grodin, a professor of health law, bioethics and human rights at Boston University School of Public Health, said he had no ethical objection to the idea of performing the same procedure in women, "but the psychosocial aspects are significant," he said. "Who is the mother of the child? Your mother was dead when you were conceived. There is an overemphasis on nature versus nurture [here]."
Family Freezes Dead Daughter's Eggs
But because of the increasing number of cases, Arthur Caplan, chairman of the department of bioethics at University of Pennsylvania, said laws and policies need to catch up with the practice.
Caplan said that laws need to be put in place that require spouses and other family members to wait a certain amount of time before using the harvested sperm or egg.
"I'm in favor of requiring waiting periods to let the emotions and grief calm down a bit," said Caplan. "And at this point, it seems very important to set up policies that will help guide us in making sound choices. That includes laws and individual hospital policies."
"[This] is a reminder of our enormous technical capacity to form families in ways that were unheard of a generation ago, and our responsibility to think carefully about the meaning and impact of the decisions we make when we take up those technologies," said Daar.