Katie Cameron

This chapter summarizes and weighs ethical issues surrounding posthumous gamete or embryo use while proposing guidelines and suggestions for how clinicians involved in assisted reproduction can best respect the rights of the deceased and surviving loved ones when the issue of posthumous reproduction is raised. The chapter covers scenarios including when the deceased’s wishes are known regarding previously cryopreserved gametes or embryos, when wishes are unknown regarding previously cryopreserved embryos, when wishes are unknown regarding previously cryopreserved gametes, and when no gametes or embryos have been previously cryopreserved. There are many ethical challenges related to the use of posthumous gametes and embryos for procreation, both when they are already cryopreserved and when retrieval is necessary. For reproductive tissue already frozen, much consternation on the part of the physician and the surviving partner can be alleviated by having clearly delineated consent forms that include use of gametes after the death of one or both partners. While the presence of cryostored gametes or embryos shows that a parental project existed, it does not definitively demonstrate that the deceased accepted the continuation of the project after their death, and while perhaps ethically permissible providers should proceed with great caution.

This chapter summarizes ethical issues surrounding planned oocyte cryopreservation, or “oocyte cryopreservation to protect against a future threat of infertility.” It proposes guidelines and suggestions for how clinicians involved in assisted reproduction can best counsel patients. It also highlights some of the larger societal implications and forces driving planned oocyte cryopreservation for both physician and patient to consider. We conclude that while it is ethical to offer planned oocyte cryopreservation, safeguards must be in place to ensure that this is done in the best interest of the patient and the technology is used responsibly. This includes recognizing at the time of a consult that patients may be feeling a sense of loss of control over their fertility and over their life goals, and discussion of family building options including the use of donor sperm for immediate conception should be included in the options presented to the patient. In addition, practitioners need to balance the natural desire to convey hope and respect for reproductive autonomy with the need to convey realistic treatment expectations. The informed consent process must emphasize that planned oocyte cryopreservation may not result in live birth, and the patient should understand the clinic’s individual oocyte thaw success rates.

The goal of our target article is to establish that electrophysiological data constrain models of short-term memory retention operations to schemes in which activated long-term memory is its representational basis. The temporary stores correspond to neural circuits involved in the perception and subsequent processing of the relevant information, and do not involve specialized neural circuits dedicated to the temporary holding of information outside of those embedded in long-term memory. The commentaries ranged from general agreement with the view that short-term memory stores correspond to activated long-term memory (e.g., Abry, Sato, Schwartz, Loevenbruck & Cathiard [Abry etal.], Cowan, Fuster, Grote, Hickok & Buchsbaum, Keenan, Hyönä & Kaakinen [Keenan et al.], Martin, Morra), to taking a definite exception to this view (e.g., Baddeley, Düzel, Logie & Della Sala, Kroger, Majerus, Van der Linden, Colette & Salmon [Majerus et al.], Vallar).

High temporal resolution event-related brain potential and electroencephalographic coherence studies of the neural substrate of short-term storage in working memory indicate that the sustained coactivation of both prefrontal cortex and the posterior cortical systems that participate in the initial perception and comprehension of the retained information are involved in its storage. These studies further show that short-term storage mechanisms involve an increase in neural synchrony between prefrontal cortex and posterior cortex and the enhanced activation of long-term memory representations of material held in short-term memory. This activation begins during the encoding/comprehension phase and evidently is prolonged into the retention phase by attentional drive from prefrontal cortex control systems. A parsimonious interpretation of these findings is that the long-term memory systems associated with the posterior cortical processors provide the necessary representational basis for working memory, with the property of short-term memory decay being primarily due to the posterior system. In this view, there is no reason to posit specialized neural systems whose functions are limited to those of short-term storage buffers. Prefrontal cortex provides the attentional pointer system for maintaining activation in the appropriate posterior processing systems. Short-term memory capacity and phenomena such as displacement of information in short-term memory are determined by limitations on the number of pointers that can be sustained by the prefrontal control systems. Key Words: coherence; event-related potentials; imaging; long-term memory; memory; short-term memory; working memory.