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This chapter explores the ethical issues with posthumous assisted reproduction for individuals who already have frozen gametes or embryos and for individuals requiring postmortem gamete retrieval. Relying on the core ethical principles of justice, beneficence/nonmaleficence, and autonomy, I analyze some of the key ethical issues raised by posthumous assisted reproduction. I then examine who (e.g., surviving partner, surviving parents, third party, etc.) should be permitted to request PAR. I draw heavily on the guidelines issued by the ethics committees of the American Society for Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE).

This chapter examines some of the ethical concerns that arise in the interdisciplinary field of oncofertility. Specifically, I will address three commonly asked ethical questions: (1) Who should be offered fertility preservation? (2) Who should pay for fertility preservation? and (3) How should disputes over frozen gametes, embryos, and gonadal tissue (collectively referred to as reproductive material) be resolved and prevented? Unfortunately, there are not always easy and universal answers to these questions. As with other aspects of patient care, we need to consider each patient and make a case-by-case judgment.

In the United States, single individuals and LGBTQ couples who wish to conceive biological children are considered to be “socially infertile” due to their relationship status. Due to the high cost of infertility treatments and inadequate insurance coverage, the socially infertile has minimal access to assisted reproductive technology (ART). Under the current medical definitions of infertility, even in states with infertility insurance mandates, only heterosexual couples with physiological infertility are covered for ART. It is well documented that infertility interferes with many aspects of the human experience and reduces the quality of life for involuntarily childless individuals regardless of whether the infertility is physiologically or socially based. Physiological infertility was initially considered to be a private issue before being recognized as a medical diagnosis and has since legitimized heterosexual couples’ access to ARTs. The medical diagnosis of infertility not only affirms that their intention to conceive biological children is justifiable but also confirms that it is a condition that can and should be treated with current medical interventions. Expanding the current definition of infertility to include social infertility will elevate it to a treatable medical condition, justifying the use of ART for such individuals and potentially alleviating the negative impacts of infertility. Thus, states with infertility insurance mandates should provide the same infertility coverage to socially infertile individuals as physiologically infertile heterosexual couples.

Until quite recently human reproduction was considered an entirely natural process, and the ethics of reproduction were governed more by cultural mores and religious strictures than by any serious philosophical or empirical inquiry. However, more recently reproductive ethics has exploded as a field for several reasons. At a cultural level, many things taken for granted a generation ago, including the increasing medicalization of birth and the heteronormative two-parent nuclear family, have been challenged, and new possibilities have arisen from these now contested ideas. It is important to remember that the explosion of reproductive ethics is as much from new thinking as it is from new technologies, and, at least in regard to reproductive possibilities for the LGBTQ community, it may well be fair to say that it is our new thinking that then led to new technological explorations.

In this chapter, we focus exclusively on informed consent in sperm banking only with respect to sperm freezing for autologous use. We consider the necessary legal and ethical elements and individuals to be included in this process. We begin by considering the legal and ethical underpinnings of informed consent. We then explore the elements of consent that are necessary for adults preserving sperm followed by a discussion of the unique components of informed consent when a minor’s sperm is being cryopreserved. The chapter concludes with a list of recommended elements to consider in developing an informed consent process for sperm banking for autologous use.

When we first envisioned organizing a conference solely on issues in reproductive ethics we were met by some skepticism by friends and colleagues. Were there really enough compelling topics and scholarship in this area to sustain interest for a 2-day conference? Our view, and the perspective confirmed by this book, is that reproductive ethics is a field that has many questions, which we have only started to explore to the extent that they deserve. There are two reasons this is true. One is that some “hot button” issues have received all the attention—abortion, in particular, comes to mind here. The other is that unlike many well-litigated areas of bioethics, such as end-of-life care, emerging technologies in reproductive ethics are changing the ethical playing field faster than the bioethics literature can keep pace. As for whether reproductive ethics can sustain interest we can only note that it is hard to imagine a subject that humans spend more time and energy upon than sex and reproduction. It is the only area of bioethics that can be called sexy without invoking an implausible metaphor.

According to recent estimates, there are more than 270,000 survivors of pediatric cancer and long-term survivorship for pediatric cancer is around 80 % [28]. Given the large number of survivors as well as the high survivorship rate, coupled with the fact that pediatric cancer survivors typically have a full lifetime ahead of them, it is increasingly important to examine their quality of life issues. Our goal in this chapter is to highlight some of the ethical issues that arise in the context of fertility preservation for pediatric cancer patients and survivors. Specifically, we explore assent/consent, best interest standard, parental and provider pressure, cost and insurance coverage, and experimental treatment.