Faculty Bibliography

Older parenthood raises a variety of important factual and ethical questions. None of the questions have received sufficient attention despite the rapid expansion in the United States and other nations in the numbers of older parents. We do not know much about the safety, economic, and psychosocial impact of these emerging practices on children or parents. Nor have there been many analytical considerations of the ethical issues raised. We argue in this article that there are reasons for concern when older persons seek to utilize fertility treatments, including the safety of pregnancy for older women, risks posed to children delivered by older mothers, issues around what constitutes safe conditions for having a child relative to the age of parents, and the importance of guaranteeing that someone will serve in the parental role should an older parent or parents become disabled or die. To protect the best interest of children created by technology in new familial circumstances, internationally recognized and enforced standards for fertility clinics to follow ought to be enacted in making decisions about treating older parents seeking infertility services.

Fertility preservation is a newly developed branch of reproductive medicine aimed at preserving the potential for genetic parenthood in adults of reproductive age or children, who are at risk of sterility before undergoing anticancer treatments. Except for embryo and semen freezing, all the available options to preserve fertility are considered experimental and thus, they raise ethical issues. In this study, we reviewed the informed consent and the risk-benefit analysis of offering experimental procedures for both adults and children when they are in vulnerable situations. In particular, children represent a special category of patients and their assent to treatment to be sought at anytime should be possible. Overall, there should be no ethical objections to offer these services as they are offered with the scope of preserving future fertility.

Competing visions for health reform in the United States and renewed interest in health technology assessment (HTA) have led to fierce national debates about the appropriateness of rationing. Because of a limited supply of organs, kidney transplantation has always required rationing and overt discussion of the ethics that guide it, but the field of transplantation has also contended recently with internal calls for a new rationing system. The aim of the Life Years from Transplantation (LYFT) proposal is to allocate kidneys to patients who obtain the greatest survival benefit from transplantation, which would lengthen the lives of kidney transplant recipients but restrict the ability of older Americans to obtain a transplant. The debate around the LYFT proposal reveals the ethical and policy challenges of identifying which patients should receive a treatment based on the results of cost-effectiveness and other HTA studies. This article argues that attempts to use HTA for healthcare rationing are likely to disadvantage older patients. Guiding principles to help ensure that resources such as kidneys are justly allocated across the life span are proposed.