Surplus embryos in IVF units in Israel: patients' attitude towards various dispositions-a bioethical analysis of empirical findings

Owing to its pro-natalist approach, Israel is considered as an in-vitro fertilization (IVF) superpower. With the high number of state-funded IVF treatments, IVF units find themselves stranded with around a million cryopreserved 'surplus' embryos; namely, embryos neglected or forgotten by patients, or abandoned due to personal or familial circumstances. The accumulation of such a vast number of surplus embryos creates operational and economic burdens for IVF units. Attempting to better comprehend this predicament, we conducted a survey. Its findings serve as a basis for the theoretical analysis provided in this article, which is based on the tension between reproductive autonomy on the one hand, and solidarity and personal responsibility, on the other. The survey examined present and former IVF patients' attitudes towards relevant dispositions for surplus embryos in Israel. Our findings indicated that patients express an individualistic approach to autonomy, which was reflected, for example in reluctance to donate their surplus embryos to research or discard them, even years after completing their IVF treatments. These findings and others led us to conclude that a solidarity-based policy should be imposed. We also argue that personal responsibility, via the constructs of 'participatory patienthood'-the notion of self-empowered patients taking initiative with respect to their health-should be encouraged in supporting an ethical imperative to choose a disposition for one's surplus embryos.