A grieving family's decision to donate the heart, liver and other organs of their dead 21-year-old son has been welcomed, even honoured. But their demand to save another part of his body - sperm - is far more contentious, traversing an ethical, moral and legal minefield.
US Military Academy Cadet Peter Zhu was fatally injured last month in a skiing accident at West Point.
Distraught, parents Yongmin and Monica Zhu hired a lawyer and went to court, seeking to save their son's sperm to memorialise him and carry on the family name.
"Our son's dying wish was to become a father and to bring children into this world," his parents wrote in a court petition filed Friday in Westchester County, New York, where Peter was being kept on life support at Westchester Medical Center. "Our family has been torn apart this week by the loss of our precious son.
"We now beg the court not to further devastate our family by eliminating the possibility of preserving some piece of our child that might live on," they said in court papers.
A judge agreed, directing the hospital to retrieve the sperm and store it pending a court hearing March 21. The Zhus could not be reached for comment on Tuesday. Attorney Joseph R Williams said he was "proud of the successful and landmark efforts made" on behalf of the Zhus but said "the case remains pending."
"As you would expect, it is a very bittersweet result for the family and, out of respect for their privacy, we cannot discuss it further at this time," Williams said.
But experts at Stanford University and the University of California, San Francisco medical centres say that sperm is not like other organs. They understand the profound loss felt by the family. But they said they only would have granted such a request by a spouse - not a parent - or with written documentation from Peter Zhu himself.
"We have a responsibility to this child," said Barry R Behr, professor of Reproductive Endocrinology and Infertility at Stanford University Medical Center. "We need to balance this terrible tragedy with the ethics of and concern for the potential resulting person."
Before his accident, Peter Zhu decided that he wanted to become an organ donor, and specified that on his California driver's licence.
The family asserts in its appeal to the court that Peter also wanted a family.
"When Peter was alive, he often told us how he wanted children of his own one day, and that he wanted to give us grandchildren," the family said in its court filing. "Peter told us that he wanted to have five children, and that his dream was to live on a ranch with his family and raise horses. We often joked that it would be expensive to raise five children, but Peter was adamant that he wanted a large family."
The sperm would offer them solace, as well, they said. "We are desperate to have a small piece of Peter that might live on and continue to spread the joy and happiness that Peter brought to all of our lives."
And there are deep cultural reasons to save it, they added. Peter was their only son, and because of China's one-child policy, there are no male cousins.
"Our family comes from China and an extremely important part of our Chinese culture is the tradition of carrying on our family lineage," they said.
As advances continue in the area of assisted reproduction, requests for sperm procurement from the dying or recently deceased is becoming more frequent, according to 2013 research published in the journal Fertility and Sterility by pediatrician David Magnus, director of the Stanford Center for Biomedical Ethics and co-Chair of the Ethics Committee for the Stanford Hospital.
But the law in the United States is largely silent about the procedure. And unlike organs and tissues, which are donated to others to save lives, sperm is classed as a renewal tissue and is not explicitly included in the Uniform Anatomical Gift Act. Use of the sperm through in vitro fertilisation or surrogacy is regulated by individual states.
Some other nations have reached societal consensus about posthumous sperm retrieval, he said. Holland and some other European nations prohibit it. In contrast, Israel is supportive.
Although there is no governmental regulation of United States, several professional societies have issued recommendations.
The American Society for Reproductive Medicine recommends that "in the absence of a written directive, it is reasonable to conclude that physicians are not obligated to comply with either request (for sperm extraction or use of extracted sperm) from a surviving spouse or partner." Its guidelines say that sperm requests should be granted only to surviving spouses or life partners, not parents, and that there should be a grieving period before sperm is used.
The Westchester hospital lacked expertise or an established protocol - so it was faced with a difficult decision at the time of the family's urgent request. Because the hospital had never conducted the procedure under such circumstances, it sought authorisation from New York Supreme Court Judge John Colangelo.
Stanford and UCSF say the decision is too important to be rushed. Their policies were created by teams, over time.
Before rushing to retrieve the sperm, future challenges must be considered, the doctors agreed.
"With whom would he have wanted to have the child?" asked James F Smith, director of Male Reproductive Health in the Department of Urology at UCSF. "Where would the egg come from, his mum? A stranger? Would he have trusted his mother or father to pick an egg donor? Who will raise the child?"
The Mercury News