Retrieving semen from a dead patientUtilitarianism in the absence of definitive guidelinesThe patient was assaultedSome ethical concerns were ignoredAn ethic of ambivalenceBMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7172.1583 (Published 05 December 1998) Cite this as: BMJ 1998;317:1583
Retrieving semen from a dead patient
Although guidelines for retrieving semen from dead patients exist, they may not cover every case. Here, a team of doctors describes the case of a man who underwent orchidectomy after being certified brain dead, and an obstetrician, neurosurgeon, and sociologist debate the ethical issues.
Utilitarianism in the absence of definitive guidelines
- Michael Swinn, registrar, department of uro-neurologya,
- Mark Emberton, senior lecturerb,
- David Ralph, consultantb,
- Martin Smith, consultant, department of surgical intensive carea,
- Paul Serhal, headc
- National Hospital for Neurology and Neurosurgery, London WC1N 3BG
- Institute of Urology and Nephrology, London W1P 7PN
- Assisted Conception Unit, University College Hospital, London WC1E 6DB
- Department of Obstetrics and Gynaecology, Guy's and St Thomas's Hospital Trust, London SE1 7AE
- Russian Postgraduate Medical Academy, Fadeeva Str 5-21, Moscow 125047, Russia
- Department of Sociology, University of Warwick, Coventry CV 7AL
- Correspondence to: Mr Swinn
Late at night, after a sudden collapse and grand mal seizure, a 41 year old man was transferred to the intensive care unit of our hospital. He was known to have a right cerebral arteriovenous malformation and had survived two intracerebral haemorrhages (in 1994 and 1996). The patient had had a respiratory arrest before admission, and had been intubated and ventilated before he arrived. His Glasgow coma score was 3/15, and his pupils were fixed and dilated. Computed tomography showed massive intracerebral bleeding. In due course, brain stem death was confirmed according to standard criteria.
The following day the patient's wife came to see us with a paper on which the following was typed: “I confirm that in the circumstances of my death, I give consent to my sperm being saved for my wife to have our children in the future.” It was signed by the patient and dated some time the previous year. Since there was no general urology service at the hospital, the uroneurology registrar was contacted for his advice. When he arrived he found that the patient's wife had given consent to multiorgan donation (except corneas, bone, and skin), and arrangements were in place for this to go ahead. Two teams of transplant surgeons were already on their way. The registrar was then given the paper and told that the couple had been attending a fertility clinic where the wife had been assured that her husband had produced normal spermatozoa. None, however, had been stored.
Not having been involved with semen retrieval before, …