APHON Pediatric Chemotherapy-Biotherapy Renewal

Ethical and Legal Considerations Pediatric fertility preservation raises several ethical and legal concerns. First and foremost is the obtaining of consent (for older patients) or assent (for younger patients); the specified ages vary by state. Disagreements between the parent and the adolescent child are difficult to manage. The critical concern in this situation is the extent of involvement of the minor child. The patient’s family and the medical team should work together to provide an open future for the patient. The principle of an open future rests on the moral duty to protect the rights of children, especially in relation to important decisions being made before the child reaches the age of consent. For adolescent patients, it is recommended that their feelings about such decisions be solicited without a parent or guardian present. It is also important to have these conversations regardless of a child’s sexual orientation. When conflict occurs, it is prudent to hold a consultation with an ethics professional or a mental health professional. Any disposition of gametes should be delayed until the child reaches the age of consent. For children who do not survive into adulthood, their eggs and ovarian tissue or sperm and testicular tissue should be destroyed. This practice is consistent with recommendations made by the American Society for Reproductive Medicine (Ethics Committee of the American Society for Reproductive Medicine, 2013). References Burns, K. C., Boudreau, C., & Panepinto, J. A. (2006). Attitudes regarding fertility preservation in female adolescent cancer patients. Journal of Pediatric Hematology/Oncology , 28 (6), 350– 354. https://doi.org/10.1097/00043426-200606000-00006 Del-Pozo-Lérida, S., Salvador, C., Martínez-Soler, F., Tortosa, A., Perucho, M., & Giménez-Bonafé, P. (2019). Preservation of fertility in patients with cancer (Review). Oncology Reports , 41 (5), 2607–2614. https://doi.org/10.3892/or.2019.7063 Ethics Committee of the American Society for Reproductive Medicine (2013). Posthumous collection and use of reproductive tissue: A committee opinion. Fertility and Sterility , 99 (7), 1842–1845. https://doi.org/10.1016/j.fertnstert.2013.02.022 Halpern, J. A., Das, A., Faw, C. A., & Brannigan, R. E. (2020). Oncofertility in adult and pediatric populations: Options and barriers. Translational Andrology and Urology , 9 (Suppl 2), S227– S238. https://doi.org/10.21037/tau.2019.09.27 Howlader N., Noone, A. M., Krapcho, M., Miller, D, Brest, A., Yu, M., Ruhl, J., Tatalovich, Z., Mariotto, A., Lewis, D. R., Chen, H. S., Feuer, E. J., & Cronin, K. A. (Eds). (2021). SEER Cancer Statistics Review (CSR), 1975–2018, National Cancer Institute. https://seer.cancer.gov/csr/1975_2018/, based on November 2020 SEER data submission, posted to the SEER web site, April 2021.