Journal of Bioethical Inquiry

, Volume 13, Issue 3, pp 369–379 | Cite as

Donor Conception Disclosure: Directive or Non-Directive Counselling?

  • Inez Raes
  • An Ravelingien
  • Guido Pennings
Original Research


It is widely agreed among health professionals that couples using donor insemination should be offered counselling on the topic of donor conception disclosure. However, it is clear from the literature that there has long been a lack of agreement about which counselling approach should be used in this case: a directive or a non-directive approach. In this paper we investigate which approach is ethically justifiable by balancing the two underlying principles of autonomy (non-directive approach) and beneficence (directive approach). To overrule one principle in favour of another, six conditions should be fulfilled. We analyse the arguments in favour of the beneficence principle, and consequently, a directive approach. This analysis shows that two conditions are not met; the principle of autonomy should not be overridden. Therefore, at this moment, a directive counselling approach on donor conception disclosure cannot be ethically justified.


Counselling Ethics Donor conception Secrecy Disclosure 


  1. Allan, S. 2012. Donor conception, secrecy and the search for information. Journal of Law and Medicine 19(631): 631–650.PubMedGoogle Scholar
  2. American Society for Reproductive Medicine. 2013. Recommendations for gamete and embryo donation: A committee opinion. Fertility and Sterility 99(1): 47–62.CrossRefGoogle Scholar
  3. Association of Biomedical Andrologists, Association of Clinical Embryologists, British Andrology Society, British Fertility Society, and Royal College of Obstetricians and Gynaecologists. 2008. UK guidelines for the medical and laboratory screening of sperm, egg and embryo donors. Human Fertility 11(4): 201–210.CrossRefGoogle Scholar
  4. Australian and New Zealand Infertility Counsellors Association. 2012. Donor conception: Ethical aspects of information disclosure. Submission to Nuffield Council on Bioethics. Accessed September 1, 2013.
  5. Baran, A., and R. Pannor. 1993a. Lethal secrets: the psychology of donor insemination. Problems and solutions, 2nd ed. New York: Amistad Press.Google Scholar
  6. Baran, A., and R. Pannor. 1993b. Perspectives on open adoption. Adoption 3(1): 119–124.Google Scholar
  7. Bernhardt, B.A. 1997. Empirical evidence that genetic counseling is directive: Where do we go from here? American Journal of Human Genetics 60(17): 17–20.PubMedPubMedCentralGoogle Scholar
  8. Beauchamp, T., and J. Childress. 2013. Principles of biomedical ethics, 7th ed. New York: Oxford University Press.Google Scholar
  9. British Association of Counselling and Psychotherapy. 2013. Ethical framework for good practice in counselling & psychotherapy. Leicestershire: BACP.Google Scholar
  10. British Infertility Counselling Association. 2013. Guidelines for good practice in infertility counselling: Third edition 2012. Human Fertility 16(1): 73–88.Google Scholar
  11. Blyth, E. 2012. Guidelines for infertility counselling in different countries: Is there an emerging trend? Human Reproduction 27(7): 2046–2057.CrossRefPubMedGoogle Scholar
  12. Blyth, E., L. Frith, C. Jones, and J.M. Speirs. 2009. The role of birth certificates in relation to access to biographical and genetic history in donor conception. International Journal of Children’s Rights 17(2): 207–233.CrossRefGoogle Scholar
  13. Boivin, J., T.C. Appleton, P. Baetens, et al. 2001. Guidelines for counselling in infertility: Outline version. Human Reproduction 16(6): 1301–1304.CrossRefPubMedGoogle Scholar
  14. Boivin, J. 2003. A review of psychosocial interventions in infertility. Social Sciences & Medicine 57(12): 2325–2341.Google Scholar
  15. Bonte, P., G. Pennings, and S. Sterckx. 2014. Is there a moral obligation to conceive children under the best possible conditions? A preliminary framework for identifying the preconception responsibilities of potential parents. BMC Medical Ethics 15(5): 1–10.Google Scholar
  16. Brewaeys, A., I. Ponjaert, E.V. Van Hall, and S. Golombok. 1997. Donor insemination: Child development and family functioning in lesbian mother families. Human Reproduction 12(6): 1349–1359.CrossRefPubMedGoogle Scholar
  17. British Medical Association. 2008. Parental responsibility: Guidance from the British Medical Association. Accessed October 1, 2014.
  18. Canadian Fertility and Andrology Society Counselling Special Interest Group. 2009. Assisted human reproduction counselling practice guidelines. Accessed September 1, 2014.
  19. Caughlin, J.P., and T.D. Afifi. 2004. When is topic avoidance unsatisfying? Examining moderators of the association between avoidance and dissatisfaction. Human Communication Research 30(4): 479–513.Google Scholar
  20. Cook, R., S. Golombok, A. Bish, and A. Murray. 1995. Keeping secrets: A study of parental attitudes towards telling about donor insemination. American Journal of Orthopsychiatry 65(4): 549–559.CrossRefPubMedGoogle Scholar
  21. Culley, L., and N. Hudson. 2007. Public understandings of science: British South Asian men’s perceptions of third party assisted conception. The International Journal of Interdisciplinary Social Sciences 2(4): 79–86.CrossRefGoogle Scholar
  22. Daar, J.F., and R.G. Brzyski. 2009. Genetic screening of sperm and oocyte donors: Ethical and policy implications. The Journal of American Medical Association 302(15): 1702–1704.CrossRefGoogle Scholar
  23. Daniels, K.R., V.M. Grace, and W.R. Gillet. 2011. Factors associated with parents’ decisions to tell their adult offspring about the offspring’s donor conception. Human Reproduction 26(10): 2783–2790.CrossRefPubMedGoogle Scholar
  24. Daniels, K., W. Gillet, and V. Grace. 2009. Parental information sharing with donor insemination conceived offspring: A follow-up study. Human Reproduction 24(5): 1099–1105.CrossRefPubMedGoogle Scholar
  25. De Wert, G., W.J. Dondorp, and B.M. Knoppers. 2012. Preconception care and genetic risk: Ethical issues. Journal of Community Genetics 3(3): 221–228.CrossRefPubMedGoogle Scholar
  26. Dondorp, W., G. De Wert, G. Pennings, et al. 2014. ESHRE Task Force on Ethics and Law 21: Genetic screening of gamete donors: Ethical issues. Human Reproduction 29(7): 1353–1359.Google Scholar
  27. Edwards, J. 2009. The matter of kinship. In European kinship in the age of biotechnology, edited by J. Edwards and C. Salazar, 1–18. New York and Oxford: Berghahn Books.Google Scholar
  28. Ethics Committee of the American Society for Reproductive Medicine. 2004. Informing offspring of their conception by gamete donation. Fertility and Sterility 81(3): 527–531.CrossRefGoogle Scholar
  29. Ethics Committee of the American Society for Reproductive Medicine. 2013. Informing offspring of their conception by gamete donation. Fertility and Sterility 100(1): 45–49.CrossRefGoogle Scholar
  30. Feast, J. 2003. Using and not losing the messages from the adoption experience for donor-assisted conception. Human Fertility 6(1): 41–45.CrossRefPubMedGoogle Scholar
  31. Golombok, S., A. Brewaeys, M.T. Giavazzi, et al. 2002a. The European study of assisted reproduction families: The transition to adolescence. Human Reproduction 17(3): 830–840.CrossRefPubMedGoogle Scholar
  32. Golombok, S., F. MacCallum, E. Goodman, and M. Rutter. 2002b. Families with children conceived by donor insemination: A follow-up at age 12. Child Development 73(3): 952–968.CrossRefPubMedGoogle Scholar
  33. Gottlieb, C., O. Lalos, and F. Lindblad. 2000. Disclosure of donor insemination to the child: The impact of Swedish legislation on couples’ attitudes. Human Reproduction 15(9): 2052–2056.CrossRefPubMedGoogle Scholar
  34. Haimes, E. 1988. “Secrecy”: What can artificial reproduction learn from adoption? International Journal of Law and the Family 2(1): 46–61.CrossRefPubMedGoogle Scholar
  35. Hammarberg, K., M. Carmichael, L. Tinney, and A. Mulder. 2008. Gamete donors’ and recipients’ evaluation of donor counselling: A prospective longitudinal cohort study. The Australian and New Zealand Journal of Obstetrics and Gynaecology 48(6): 601–606.Google Scholar
  36. Hayden, J. 2005. Genetics: Uphold the rights of all clients to informed decision-making and voluntary action. Nursing Standard 20(3): 48–51.CrossRefGoogle Scholar
  37. Hertz, R., M.K. Nelson, and W. Kramer. 2013. Donor conceived offspring conceive of the donor: The relevance of age, awareness, and family form. Social Science & Medicine 86(June): 52–65.CrossRefGoogle Scholar
  38. Hewitt, G. 2002. Missing links: Identity issues of donor conceived people. Journal of Fertility Counselling 9(3): 14–20.Google Scholar
  39. Horowitz, J.E., J.P. Galst, and N. Elster. 2010. Ethical dilemmas in fertility counseling. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  40. Human Fertilisation and Embryology Association. 2012. Code of practice, 8th ed. London: HFEA.Google Scholar
  41. Imber-Black, E.E., ed. 1993. In Secrets in families and family therapy. New York: Norton.Google Scholar
  42. Jadva, V., T. Freeman, W. Kramer, and S. Golombok. 2009. The experiences of adolescents and adults conceived by sperm donation: Comparisons by age of disclosure and family type. Human Reproduction 24(8): 1909–1919.Google Scholar
  43. Janssens, P.M.M.W., A.W. Nap, and L.F.J.M.M. Bancsi. 2011. Reconsidering the number of offspring per gamete donor in the Dutch open-identity system. Human Fertility 14(2): 106–114.CrossRefPubMedGoogle Scholar
  44. Johnson, L., K. Bourne, and K. Hammarberg. 2012. Donor conception legislation in Victoria, Australia: The “Time to Tell” campaign, donor-linking and implications for clinical practice. Journal of Law and Medicine 19(4): 803–819.PubMedGoogle Scholar
  45. Kainz, K. 2001. The role of the psychologist in the evaluation and treatment of infertility. Women’s Health Issues 11(6): 481–485.CrossRefPubMedGoogle Scholar
  46. Kessler, S. 1997. Genetic counseling is directive? Look again. American Journal of Human Genetics 61(2): 466–467.CrossRefPubMedPubMedCentralGoogle Scholar
  47. Kirkman, M. 2003. Parents’ contributions to the narrative identity of offspring of donor-assisted conception. Social Science & Medicine 57(11): 2229–2242.CrossRefGoogle Scholar
  48. Kirkman, M. 2004. Genetic connection and relationships in narratives of donor assisted conception. Australian Journal of Emerging Technologies and Society 2(1): 1–20.Google Scholar
  49. Kirklin, D. 2007. Framing, truth telling and the problem with non-directive counseling. Journal of Medical Ethics 33(1): 58–62.CrossRefPubMedPubMedCentralGoogle Scholar
  50. Klock, S. 1997. The controversy surrounding privacy or disclosure among donor gamete recipients. Journal of Assisted Reproduction and Genetics 14(7): 378–380.CrossRefPubMedPubMedCentralGoogle Scholar
  51. Klock, S. 2013. Disclosure decisions among known and anonymous egg donor recipients. In Principles of oocyte and embryo donation, edited by M.V. Sauer, 195–204. London: Springer-Verlag.Google Scholar
  52. Lalos, A., C. Gottlieb, and O. Lalos. 2007. Legislated right for donor-insemination children to know their genetic origin: A study of parental thinking. Human Reproduction 22(6): 1759–1768.Google Scholar
  53. Landau, R. 1998. The management of genetic origins: Secrecy and openness in donor-assisted conception in Israel and elsewhere. Human Reproduction 13(11): 3268–3273.CrossRefPubMedGoogle Scholar
  54. Lindblad, F., C. Gottlieb, and O. Lalos. 2000. To tell or not to tell—what parents think about telling their children that they were born following donor insemination. Journal of Psychosomatic Obstetrics and Gynecology 21(4): 193–203.CrossRefPubMedGoogle Scholar
  55. Lycett, E., K. Daniels, R. Curson, and S. Golombok. 2004. Offspring created as a results of donor insemination: A study of family relationships, child adjustment, and disclosure. Fertility and Sterility 82(1): 172–179.CrossRefPubMedGoogle Scholar
  56. MacCallum, F., S. Golombok, and P. Brinsden. 2007. Parenting and child development in families with a child conceived through embryo donation. Journal of Family Psychology 21(2): 278–287.CrossRefPubMedGoogle Scholar
  57. Maron, B.J., J.R. Lesser, N.B. Schiller, K.M. Harris, C. Brown, and H.L. Rehm. 2009. Implications of hypertrophic cardiomyopathy transmitted by sperm donation. The Journal of American Medical Association 302(15): 1681–1684.CrossRefGoogle Scholar
  58. McGee, G., S.-V. Brakman, and A.D. Gurmankin. 2001. Gamete donation and anonymity: Disclosure to children conceived with donor gametes should not be optional. Human Reproduction 16(10): 2033–2036.CrossRefPubMedGoogle Scholar
  59. McHaffie, H.E., I.A. Laing, M. Parker, and J. McMillan. 2001. Deciding for imperilled newborns: Medical authority or parental autonomy? Journal of Medical Ethics 27(2): 104–109.CrossRefPubMedPubMedCentralGoogle Scholar
  60. McWhinnie, A.M. 1984. Annex: The case for greater openness concerning AID. In AID and after: Papers from BAAF, BASW and a Scottish Working Party. London: British Agencies for Adoption and Fostering.Google Scholar
  61. McWhinnie, A.M. 2001. Gamete donation and anonymity: Should offspring from donated gametes continue to be denied knowledge of their origins and antecedents? Human Reproduction 16(5): 807–817.CrossRefPubMedGoogle Scholar
  62. Nachtigall, R.D. 1993. Secrecy: An unresolved issue in the practice of donor insemination. American Journal of Obstetrics and Gynecology 168(6): 1846–1851.CrossRefPubMedGoogle Scholar
  63. Nachtigall, R.D., J.M. Tschann, S.S. Quiroga, L. Pitcher, and G. Becker. 1997. Stigma, disclosure and family functioning among parents of children conceived through donor insemination. Fertility and Sterility 68(1): 83–89.CrossRefPubMedGoogle Scholar
  64. Nachtigall, R.D., G.B. Becker, S. Szkupinski, and J.M. Tschann. 1998. The disclosure decision: Concerns and issues of parents of children conceived through donor insemination. American Journal of Obstetrics and Gynecology 178(6): 1165–1170.CrossRefPubMedGoogle Scholar
  65. Nordqvist, P., and C. Smart. 2014. Relative strangers: Family life, genes and donor conception. Basingstoke, UK: Palgrave Macmillan.Google Scholar
  66. Nuffield Council on Bioethics. 2013. Donor conception: ethical aspects of information sharing. London: Nuffield Council on Bioethics.Google Scholar
  67. Oduncu, F.S. 2002. The role of non-directiveness in genetic counseling. Medicine, Health Care and Philosophy 5(1): 53–63.CrossRefGoogle Scholar
  68. Owen, L., and S. Golombok. 2009. Families created by assisted reproduction: Parent-child relationships in late adolescence. Journal of Adolescence 32(4): 835–848.CrossRefPubMedGoogle Scholar
  69. Peterson, B., J. Boivin, J. Norré, et al. 2012. An introduction to infertility counseling: A guide for mental health and medical professionals. Journal of Assisted Reproduction and Genetics 29(3): 243–248.CrossRefPubMedPubMedCentralGoogle Scholar
  70. Ravitsky, V. 2012. Conceived and deceived: the medical interests of donor-conceived individuals. The Hastings Center Report 42(1): 17–22.CrossRefPubMedGoogle Scholar
  71. Ravelingien, A., and G. Pennings. 2013. The right to know your genetic parents: from open-identity gamete donation to routine paternity testing. American Journal of Bioethics 13(5): 33–41.CrossRefPubMedGoogle Scholar
  72. Rogers, C.R. 1942. Counseling and psychotherapy: Newer concepts in practice. Boston: Houghton Mifflin.Google Scholar
  73. Rumball, A., and V. Adair. 1999. Telling the story: Parents’ scripts for donor offspring. Human Reproduction 14(5): 1392–1399.CrossRefPubMedGoogle Scholar
  74. Sachs, P., and L. Hammer Burns. 2006. Recipient counseling for oocyte donation. In Infertility counseling: A comprehensive handbook for clinicians, 2nd ed., edited by S.N. Covington and L. Hammer Burns, 319–338. New York: Cambridge University Press.Google Scholar
  75. Serre, J.-L., A.-L. Leutenegger, A. Bernheim, M. Fellous, A. Rouen, and J.-P. Siffroi. 2014. Does anonymous sperm donation increase the risk for unions between relatives and the incidence of autosomal recessive diseases due to consanguinity? Human Reproduction 29(3): 394–399.CrossRefPubMedGoogle Scholar
  76. Shenfield, F. 1999. Truth or dare? Anonymity: The case for. Progress in Reproduction 3: 8.Google Scholar
  77. Shenfield, F., and S.J. Steele. 1997. What are the effects of anonymity and secrecy on the welfare of the child in gamete donation? Human Reproduction 12(2): 392–395.CrossRefPubMedGoogle Scholar
  78. Sims, C.A., P. Callum, M. Ray, J. Iger, and R.E. Falk. 2010. Genetic testing of sperm donors: Survey of current approaches. Fertility and Sterility 94(1): 126–129.CrossRefPubMedGoogle Scholar
  79. Slepian, M.L., E.J. Masicampo, N.R. Toosi, and N. Ambady. 2012. The physical burdens of secrecy. Journal of Experimental Psychology General 141(4): 619–624.CrossRefPubMedGoogle Scholar
  80. Snowden, R., and E. Snowden. 1993. The gift of a child, 2nd revised ed. Exeter, UK: University of Exeter Press.Google Scholar
  81. Strauss, B., and J. Boivin. 2001. 2.1. Counselling within infertility. In Guidelines for counseling in infertility, edited by ESHRE Taskforce SIG Psychology and Counseling. Oxford: Oxford University Press.Google Scholar
  82. Thorn, P. 2006. Recipient counseling for donor insemination. In Infertility counseling: A comprehensive handbook for clinicians, 2nd ed., edited by S.N. Covington and L. Hammer Burns, 305–318. New York: Cambridge University Press.Google Scholar
  83. Thorn, P., and T. Wischmann. 2009. German guidelines for psychosocial counselling in the area of gamete donation. Human Fertility 12(2): 73–80.CrossRefPubMedGoogle Scholar
  84. Turner, A.J., and A. Coyle. 2000. What does it mean to be a donor offspring? The identity experience of adults conceived by donor insemination and the implications for counseling and therapy. Human Reproduction 15(9): 2041–2051.CrossRefPubMedGoogle Scholar
  85. Vangelisti, A.L., and J.P. Caughlin. 1997. Revealing family secrets: The influence of topic, function, and relationships. Journal of Social and Personal Relationships 14(5): 679–705.Google Scholar
  86. Visser, M., P.A.L. Kop, M. VanWel, F. Van der Veen, G.J.E. Gerrits, and M.C.B. Van Zwieten. 2012. Counselling on disclosure of gamete donation to donor offspring: A search for facts. Facts, Views and Vision in Obstetrics and Gynaecology 4(3): 159–172.Google Scholar
  87. Xafis, V., D. Wilkinson, L. Gillam, and J. Sullivan. 2014. Balancing obligations: Should written information about life-sustaining treatment be neutral? Journal of Medical Ethics. doi: 10.1136/medethics-2013-101965.PubMedPubMedCentralGoogle Scholar

Copyright information

© Journal of Bioethical Inquiry Pty Ltd. 2016

Authors and Affiliations

  1. 1.Bioethics Institute Ghent (BIG), Department of Philosophy and Moral ScienceGhent UniversityGentBelgium

Personalised recommendations