Nursing Ethics and Posthumous Sperm Insemination Dilemmas

Introduction: Medical Possibility and Ethical Complexity

Today, medical science is capable of things only imagined in the past. One of these possibilities stems from the techniques of in vitro fertilization and cryobiology. It is now possible to freeze a man's sperm and impregnate a woman with it at some future time. This practice raises many ethical issues as far as the legal profession is concerned, primarily informed consent, ownership of the sperm, and several other matters. It also raises important questions for the medical profession. The central question is not simply whether the procedure is possible, but whether it should be performed at all. This paper examines the role of the nurse in relation to her ethical obligations and the moral issues imposed upon her by this complex situation.

The Case and the Nurse's Dilemma

A court case recently surfaced in which a woman wants her deceased fiancé's sperm inseminated into her in order to become pregnant with his child. The couple was not married at the time, although she claims they had plans to marry and start a family. Family and friends also considered it common knowledge that the couple wished to have children in the near future. The fiancé died in an accident, and the girlfriend discovered that he had been a sperm donor for money while attending college. She claims it is her right to have his baby via the frozen sperm, and that to deny her this would be denying a dead man his wishes (Woman Clings…, 2003).

While the primary issues surrounding this example are legal, the medical profession becomes involved because its members will be the ones who ultimately perform the procedure if the courts allow it. Currently the court is not in favor of permitting the procedure. The medical profession is bound to abide by the law and follow any court order pertaining to a case. It also has an obligation to allow patients to retain a degree of autonomy in making their own decisions. In this case, the court and the potential patient are in direct disagreement.

Consider a hypothetical scenario: the patient decides to disregard the court order and comes to a registered nurse for advice on how to proceed with the procedure anyway. How should the nurse respond? The strictly legal answer would be that the nurse should advise the patient not to go ahead, since doing so would violate a court order. However, that answer conflicts with the nurse's code of ethics, which holds that she should refrain from making judgments on behalf of the patient and that, if the patient wishes to have a procedure, the nurse does not have the right to interfere. Similar tensions arise in discussions of euthanasia (Davies, 2002). The key question is: where does court jurisdiction end, and where do medical ethics override court decisions—or can they at all? It also raises the broader issue of how much freedom individuals have in determining what happens to their own bodies. When medicine and the courts intersect, there are seldom any easy answers.