COMMENTARY

Freeze the Eggs and Sperm of US Troops as a Perk of Combat?

Arthur L. Caplan, PhD

Disclosures

March 18, 2016

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I'm Art Caplan at the Division of Medical Ethics at the New York University (NYU) Langone Medical Center. Defense Secretary Ash Carter recently made an announcement that has interesting ethical implications.[1] He announced a pilot program for the next 2 years offering members of the armed services the opportunity for fertility preservation; so if they deploy and are killed, their frozen sperm or eggs will still be available. The Department of Defense (DoD) will help pay these costs while evaluating the success of this program. There are many women in the military, so we're not just talking about sperm banking but also egg freezing.

One motive of this program is to keep women who are in the armed forces on active duty by giving them the choice to have children later using their preserved eggs, without interrupting their careers. Extending the opportunity to have children later in life also makes the workplace more family friendly, by permitting greater access to daycare, homecare, and extended family leave. This could make it easier to balance career and family, which is an option that some women and men might want to pursue.

Other ethical issues have to be addressed here, and I'm not sure that the DoD has completely thought them through. What happens if an individual who has left behind sperm or eggs dies and their spouse says, "I don't want them. I don't want a child without my spouse." What if the parents of the deceased say, "We want grandchildren." Will they be allowed access to those gametes? Will the DoD pay for the costs involved in using them? The grandparents might say, "We want to have a surrogate mother carry the child, so if the wife or husband doesn't want this done under these circumstances, then we as grandparents do."

Egg freezing isn't quite the same as sperm freezing, although it works. There have been plenty of babies born from frozen eggs, but it's still newer and less established technology. So there is no guarantee that you're going to be able to have a child from frozen eggs. How the informed consent will be handled is another major question. What happens if the sperm bank or the infertility program goes broke? Who gets the gametes if the donor has died in combat? How is that going to be handled? If a man preserves his sperm and his wife decides to use it, will any children that result be eligible for military benefits? Will this be true even if the child is conceived after the father's death, which would make the child ineligible for benefits?

Fertility preservation is now an option—an interesting idea and something, by the way, that other countries have tried. Israel, for example, has a fertility preservation program for its armed forces.

Fertility preservation presents some challenges that we haven't resolved, like: How do you handle issues about who can use reproductive materials after death? How many children can you make? Can the gametes be frozen across generations forever? What happens if you're not married but your partner wants access to the gametes? Who gets the military benefits? These questions have to be thought through more carefully than the DoD has done, and the launch of this program is a good starting point for discussion and answers to the challenges associated with fertility preservation. I'm Art Caplan at the Division of Medical Ethics at the NYU Langone Medical Center. Thank you for watching.

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