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山东大学学报 (医学版) ›› 2019, Vol. 57 ›› Issue (10): 60-66.doi: 10.6040/j.issn.1671-7554.0.2019.771

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辅助生殖技术常见的伦理问题及管理

谭季春,董萌,李萍萍   

  1. 中国医科大学附属盛京医院生殖医学中心 辽宁省生殖障碍疾病与生育力重塑重点实验室, 辽宁 沈阳 110022
  • 发布日期:2022-09-27
  • 通讯作者: 谭季春. E-mail:tjczjh@163.com
  • 基金资助:
    国家重点研发计划(2018YFC1002105);辽宁省重点研发计划指导计划(2018225093)

Common ethical issues on assisted reproductive technology and their management

TAN Jichun, DONG Meng, LI Pingping   

  1. Reproductive Medicine Center, Shengjing Hospital of China Medical University;
    Key laboratory of Reproductive Dysfunction Diseases and Fertility Remodeling, Shenyang 110022, Liaoning, China
  • Published:2022-09-27

摘要: 随着辅助生殖技术的广泛应用,由此引发的伦理问题日益增多。因涉及到卵子、精子及胚胎,故辅助生殖技术需要更加注重生命伦理道德及法律行为。针对辅助生殖技术中常见的伦理问题:精子捐赠、卵母细胞捐赠、冻存胚胎在夫妻离异或死亡情况下的处理、高龄、代孕及多胎妊娠与减胎的伦理冲突等问题进行讨论,寻求从法律保障、规范管理、伦理监督、行业自律4个方面全面解决这些问题, 促进我国辅助生殖技术的健康有序发展,使辅助生殖技术的研究和应用惠及民生。

关键词: 辅助生殖技术, 伦理, 管理

Abstract: The widespread use of assisted reproductive technology(ART)has resulted in an increasing number of ethical issues. As ART involves eggs, sperm and embryos, more attention should be paid to life ethics and legal behaviors. This article discusses common ethical issues in ART, including sperm donation, egg donation, disposal of frozen embryos in the case of divorce or death of a married couple, advanced age, gestational surrogacy, ethical conflict of multiple pregnancy and fetal reduction. From perspectives of legal guarantee, standardized management, ethical supervision and industry self-discipline, we seek to deal with these issues, in order to promote the healthy and orderly development of ART in China, and make ART research and application benefit patients livelihood.

Key words: Assisted reproductive technology, Ethics, Management

中图分类号: 

  • R711
[1] 林方方, 哈灵侠. 辅助生殖技术助孕后母亲与子代健康状况评估[J]. 宁夏医学杂志, 2017, 39(4): 379-381.
[2] Schleissing S, Kersten J, Thaler CJ, et al. Ethical issues currently being discussed in relation to reproductive medicine and the laws governing reproductive medicine [J]. Geburtshilfe Frauenheilkd, 2014, 74(5): 436-440.
[3] Mascola L, Guinan ME. Screening to reduce transmission of sexually transmitted diseases in semen used for artificial insemination [J]. N Engl J Med, 1986, 314(21): 1354-1359.
[4] McWhinnie A. Gamete donation and anonymity: should offspring from donated gametes continue to be denied knowledge of their origins and antecedents? [J]. Hum Reprod, 2001, 16(5): 807-817.
[5] Anger JT, Gilbert BR, Goldstein M. Cryopreservation of sperm: Indications, methods and results [J]. J Urol, 2003, 170(4 Pt 1): 1079-1084.
[6] Shapiro S, Saphire DG, Stone WH. Changes in American A.I.D. practice during the past decade [J]. Int J Fertil, 1990, 35(5): 284-291.
[7] 应可满, 任建枝. 人类辅助生殖技术临床实践中的伦理问题及对策[J]. 中国医院管理, 2012, 32(9): 54-55. YING Keman, REN Jianzhi. Ethical problems and countermeasures of clinical practice of human assisted reproductive technology [J]. Chinese Hospital Management, 2012, 32(9): 54-55.
[8] Serre JL, Leutenegger AL, Bernheim A, et al. Does anonymous sperm donation increase the risk for unions between relatives and the incidence of autosomal recessive diseases due to consanguinity? [J]. Hum Reprod, 2014, 29(3): 394-399.
[9] Practice Committee of American Society for Reproductive Medicine, Practice Committee of Society for Assisted Reproductive Technology. Recommendations for gamete and embryo donation: a committee opinion[J]. Fertil Steril, 2013, 99(1): 47-62.
[10] Arocho R, Lozano EB, Halpern CT. Estimates of donated sperm use in the United States: National Survey of Family Growth 1995-2017 [J]. Fertil Steril, 2019, pii: S0015-0282(19)30492-30493.
[11] 宋革, 王奇玲, 陆艳华, 等. 接受供精辅助生殖技术治疗夫妇知情同意与生育伦理知识调查研究 [J]. 国际生殖健康/计划生育杂志, 2012, 31(1): 35-37,41. SONG Ge, WANG Qiling, LU Yanhua, et al. The Investigation of ethic problem and informed consent in patients accepted assisted reproductive technique of AID [J]. Journal of International Reproductive Health/Family Planning, 2012, 31(1): 35-37,41.
[12] Sauer MV, Kavic SM. Oocyte and embryo donation 2006: reviewing two decades of innovation and controversy [J]. Reprod Biomed Online, 2006, 12(2): 153-162.
[13] Madeira JL, Crockin SL. Legal principles and seminal legal cases in oocyte donation [J]. Fertil Steril, 2018, 110(7): 1209-1215.
[14] Bracewell-Milnes T, Saso S, Abdalla H, et al. A systematic review investigating psychosocial aspects of egg sharing in the United Kingdom and their potential effects on egg donation numbers [J]. Hum Fertil(Camb), 2018, 21(3): 163-173.
[15] Ethics Committee of the American Society for Reproductive Medicine. Electronic address: ASRM@asrm.org; Ethics Committee of the American Society for Reproductive Medicine. Financial compensation of oocyte donors: an Ethics Committee opinion [J]. Fertil Steril, 2016, 106(7): e15-e19.
[16] 中华人民共和国卫生部. 人类辅助生殖技术和人类精子库伦理原则[S/OL].(2003-06-27)[2012-12-10]. http://www.moh.gov.cn/zwgkzt/pkjjy/200805/35747.shtml.
[17] Kool EM, Bos AME, van der Graaf R, et al. Ethics of oocyte banking for third-party assisted reproduction: a systematic review [J]. Hum Reprod Update, 2018, 24(5): 615-635.
[18] 中华人民共和国卫生部. 人类辅助生殖技术规范[S/OL].(2003-06-27)[2012-12-10]. http://www.moh.gov.cn/zwgkzt/pkjjy/200805/35747.shtml.
[19] Côté S, Affdal AO, Kadoch IJ, et al. Posthumous reproduction with surplus in vitro fertilization embryos: a study exploring users choices [J]. Fertil Steril, 2014, 102(5): 1410-1415.
[20] 中华人民共和国卫生部. 人类辅助生殖技术管理办法[S/OL].(2001-02-20)[2012-12-10]. http://www.moh.gov.cn/moh-kiiys/s6754/200804/20496.shtml.
[21] Ethics Committee of the American Society for Reproductive Medicine. Posthumous collection and use of reproductive tissue: a committee opinion [J]. Fertil Steril, 2013, 99(7): 1842-1845.
[22] Ethics Committee of the American Society for Reproductive Medicine. Electronic address: ASRM@asrm.org; Ethics Committee of the American Society for Reproductive Medicine. Oocyte or embryo donation to women of advanced reproductive age: an Ethics Committee opinion [J]. Fertil Steril, 2016, 106(5): e3-e7.
[23] Jiang L, Chen Y, Wang Q, et al. A Chinese practice guideline of the assisted reproductive technology strategies for women with advanced age [J]. J Evid Based Med, 2019, 12(2): 167-184.
[24] 陈子江. “二孩”生育政策后再生育的临床思考 [J]. 山东大学学报(医学版), 2017, 55(1): 1-4. CHEN Zijiang. Clinical concern of the second pregnancy under the two-child policy [J]. Journal of ShanDong University(Health Sciences), 2017, 55(1): 1-4.
[25] Zweifel JE. Last chance or too late? Counseling prospective older parents[A]. Covington SN. Fertility counseling: clinical guide and case studies[C]. Cambridge: Cambridge University Press, 2015:150-163.
[26] Braverman AM. Old, older and too old: age limits for medically assisted fatherhood? [J]. Fertil Steril, 2017, 107(2): 329-333.
[27] Pennings G. Age as a criterion for parenting competence [J]. Reprod Biomed Online, 2013, 27(2): 118-120.
[28] 李睿. 我国代孕法律制度研究[J]. 湖南工程学院学报(社会科学版), 2019, 29(1): 81-85.
[29] Practice Committee of the American Society for Reproductive Medicine, Practice Committee of the Society for Assisted Reproductive Technology. Recommendations for practices utilizing gestational carriers: a committee opinion [J]. Journal of Hunan Institute of Engineering(Social Science Edition), 2015, 103(1): e1-8.
[30] 张珺, 杨菁, 张瑜. 辅助生殖技术中代孕和无主胚胎的现状及伦理问题[J]. 广西医学, 2016, 38(1): 140-142.
[31] 张妞, 徐菊华, 张涛. “八胞胎”事件引发的伦理思考 [J]. 医学与哲学(A), 2014, 35(10A): 89-91. ZHANG Niu, XU Juhua, ZHANG Tao. Ethical reflection on the event of octuple [J]. Medicine and Philosophy, 2014, 35(10A): 89-91.
[32] 王延光. 辅助生殖技术的伦理问题与论争[J]. 中国医学伦理学, 2007, 1: 15-18. WANG Yanguang. The ethical issues and disputes on assisted reproductive technology [J]. Chinese Medical Ethics, 2007, 1: 15-18.
[33] Aparisi Miralles Á. Surrogate motherhood and woman dignity [J]. Cuad Bioet, 2017, 28(93): 163-175.
[34] 张云山, 杨琨. 构建严谨的辅助生殖技术伦理和法规管理体系[J]. 中国实用妇科与产科杂志, 2018, 34(6): 608-612. ZHANG Yunshan, YANG Kun. Establish a rigorous management system of assisted reproductive technology on ethics and regulations [J]. Chinese Journal of Practical Gynecology and Obstetrics, 2018, 34(6): 608-612.
[35] 段金良, 陈文月, 于江, 等. 辅助生殖技术实施过程中常见的伦理矛盾及对策[J]. 中国医学伦理学, 2012, 25(1): 31-33.
[36] 董莉, 董玉整. 人类辅助生殖技术临床应用的相关伦理问题探讨[J]. 中国医学伦理学, 2014, 27(4): 482-484. DONG Li, DONG Yuzheng. Ethical discussion on issues of clinical application of assisted reproductive technology[J]. Chinese Medical Ethics, 2014, 27(4): 482-484.
[37] Vieira LA, Warren L, Pan S, et al. Comparing pregnancy outcomes and loss rates in elective twin pregnancy reduction with ongoing twin gestations in a large contemporary cohort [J]. Am J Obstet Gynecol, 2019, pii: S0002-9378(19)30530-30537.
[38] Monni G, Illescas T, Iuculano A, et al. Single center experience in selective feticide in high-order multiple pregnancy: clinical and ethical issues [J]. J Perinat Med, 2016, 44(2): 161-166.
[39] Razaz N, Avitan T, Ting J, et al. Perinatal outcomes in multifetal pregnancy following fetal reduction [J].CMAJ, 2017, 189(18): E652-E658.
[40] 陈莉, 孙琴, 姚兵, 等. 对辅助生殖技术实施中的伦理问题的思考[J]. 中国医学伦理学, 2016, 29(2): 261-264. CHEN Li, SUN Qin, YAO Bing, et al. Ethical consideration about assisted reproductive technology Implementation [J]. Chinese Medical Ethics, 2016, 29(2): 261-264.
[41] American College of Obstetricians and Gynecologists Committee on Ethics. Committee Opinion No. 719: Multifetal Pregnancy Reduction [J]. Obstet Gynecol, 2017, 130(3): e158-e163.
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