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Should providers offer oncofertility to patients with a poor prognosis?

Whereas quality of life issues for cancer patients used to
minimized, and sometimes even ignored, today there is more of a focus on cancer
patients’ quality of life post-cancer. One such quality of life issue is oncofertility,
which is fertility preservation for cancer patients. In many places,
oncofertility is, or is becoming, the standard of care for cancer patients. But
should it be offered to all patients? What about patients who have a very bad

 Fertility preservation for patients with a poor prognosis
raises a host of ethical issues. Providers may worry that discussing fertility
preservation will give patients false hope about their prognosis. In other
words, these patients may feel their providers deceived them by mentioning
fertility preservation, leading them to believe that their prognosis is not as
bad as they originally thought.

Yet, at the same time, pursuing fertility preservation may
be a source of hope and happiness for patients during difficult times. It may
furnish them with mental and physical strength, making them even more motivated
to survive for the sake of their potential future children. Additionally, these
patients, and their families, may feel a degree of inner peace knowing that
part of their lives will continue on in the reproductive material even if they
are never used.

Nevertheless, some may argue that, despite any personal and
emotional benefits they may experience, offering patients with a poor prognosis
fertility preservation options is an unjust allocation of resources. From a
utilitarian perspective, it does not make sense to devote resources to patients
who will likely not benefit from them. Put differently, resources should be
allocated to those who have a high probability of a positive outcome, which
means individuals with a poor prognosis should be placed lower on the priority
list for receiving fertility preservation resources than individuals with a
good prognosis.

On the other hand, if we take a deontological (duty-based,
individual rights) approach, providers have a duty to care for their patients.
Not offering fertility preservation to all of their patients, including those
with a poor prognosis, may be seen as diminishing patient autonomy. According
to this view, providers should be more concerned with the needs and rights of
their individual patients than with social justice (i.e., fair allocation of

For more on this topic, see my book chapter “Addressing the
Three Most Frequently Asked Questions of a Bioethicist in an Oncofertility
Setting” in
Oncofertility Medical
, edited by T.K. Woodruff and C. Gracia.



The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI’s online graduate programs, please visit our website.

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