Avi Harush heard a knock on his door in early April and saw Israeli military officers outside. Instantly he knew that his son, Reef, a 20-year-old soldier who had been sent to Gaza, was dead. The officers gave him the news, and then asked an unexpected question: Did the family want doctors to extract and freeze his son’s sperm? Mr. Harush was gutted with grief, but comforted by the notion of preserving a living memory of his child. He quickly agreed.
“It was something to hold on to, knowing that we would be able to have Reef’s child,” Mr. Harush said.
It has been more than a year since the start of the Israel-Hamas war. The deaths can be counted — 43,000 Palestinians, 1,200 Israelis on Oct. 7 last year and some 400 soldiers since — but each individual loss creates an immeasurable hole, leaving families bereft and communities shattered. Children become orphans, women become widows and parents are left childless.
In Israel, however, the government and military have instituted a new protocol since the war began that offers a kind of hope for bereaved families. The Israeli military, when notifying the family of a soldier’s death, now immediately offers the option to have doctors retrieve and preserve the sperm of the deceased, a technology that was not used frequently before the war.
It’s a measure inconceivable to grieving people in Gaza, where Israel’s military campaign has nearly destroyed Gaza’s health system, with hospitals “minimally functional” and doctors performing surgery without anesthesia.
The possibility of descendants from dead soldiers — a new generation conceived from wartime loss — has incited ethically heated and legally tangled debates.
There have been more than 200 cases of posthumous sperm retrievals in Israel since the start of the Israel-Hamas war, according to data collected in early November for the Ministry of Health by Dr. Talia Eldar-Geva, a fertility expert and physician. Because many of the soldiers were young and unmarried, the vast majority — 81 percent — are done at the request of parents.
Ukraine has also turned to fertility technology. Soldiers are freezing their sperm before battle, and Ukraine’s Parliament passed a law this year allowing partners to use sperm posthumously.
But some Israeli biomedical experts argue that posthumous sperm retrieval violates the medical autonomy of the soldiers, who typically did not give permission to have their sperm preserved. They also say it will create a generation of children born without ever having had a living father. One bioethics researcher wrote that even the decision to try to have a child through posthumous sperm retrieval could “reflect the person’s failure to accept the finality of death.”
“Being a parent is not just about passing your DNA to the next generation,” said Gil Siegal, director of the Center for Health Law and Bioethics at Kiryat Ono College in Israel. “A lot of folks would say, ‘If I’m not here to rear the child, why should I want that to happen?’”
Other Israeli lawyers maintain that the desires of the bereaved should be privileged over the unknown wishes of the dead.
“Let’s hear the voice of the living,” said Tamar Katz, who teaches law and bioethics at the Technion — Israel Institute of Technology and is a legal expert on posthumous sperm retrieval. “No one knows what the dead would have said.”
How Grieving Families Decide
The extraction technique is straightforward and dates back to 1980, when a doctor in California preserved the sperm of a young man who had become brain-dead after an automobile accident. Several countries, including France, Germany and Sweden, questioned whether a deceased person could provide consent and banned the procedure. There are no laws governing it in the United States, where hospitals set their own policies. (A 2016 survey of major academic medical centers found that roughly one quarter had policies on the procedure, with some requiring prior written consent from the deceased.)
To extract sperm, a physician conducts a biopsy on the corpse, removes a square of testicle tissue, removes sperm samples and freezes them in liquid nitrogen tanks. Sperm can remain viable for 24 to 48 hours after a man’s death, according to doctors who perform the procedure, though the sooner it is retrieved, the more likely it is to lead to successful conception later, and the exact time frame of viability can vary widely.
In Israel, posthumous sperm extraction was first used in 2002 when parents asked permission from the Israeli Supreme Court to freeze the sperm of their 20-year-old son, Keivan Cohen, who had been killed during his military service by a sniper. Five years later, an Israeli civil court ruled that Mr. Cohen’s parents could use the frozen sperm to produce a grandchild, and they interviewed some 200 women before selecting a surrogate mother.
Until last year, Israeli families had to petition a court if they wanted to freeze sperm posthumously. After the start of the Israel-Hamas war, Israel’s Ministry of Health, recognizing the brief window in which the sperm remains viable, waived that requirement.
For some families, simply agreeing to a sperm retrieval brings a modicum of comfort. They don’t know whether they will ever use the genetic material, but the choice to preserve that possibility helps them feel connected to the family’s future, not only to its past and gaping loss.
“If my son’s girlfriend tells me, ‘I want to use his sperm,’ it will make me happy,” said Avi Termin, whose son Shay, 28, was killed in southern Gaza last December. “I don’t want to push her. I want to give her the chance to decide for herself if she wants to use his sperm or leave Shay’s memory as it is.”
Merav Ram is a grieving parent who was able to use the technology for her son Omri, a 28-year-old civilian who was killed on Oct. 7 when Hamas militants attacked concertgoers at the Nova Festival. Ms. Ram said deciding to preserve her son’s sperm was a source of solace amid a larger crush of grief: “We said yes immediately. Omri always wanted to be a father.”
While retrieving sperm posthumously no longer requires legal permission, using it to conceive a child does. Families and spouses must petition a civil court and offer substantial evidence that the deceased wanted to have a child, whether in the form of diary entries, iPhone notes or something else. The standard of proof is far higher for parents, and cases can take up to 12 years, according to Irit Rosenblum, an Israeli fertility lawyer.
Israel’s Parliament could consider a law on using posthumous sperm for conception, but lawyers say this is unlikely to happen before the war ends.
“This kind of legislation requires somewhat of a distant perspective,” said Dr. Siegal, the bioethics expert. “Our pain is too strong right now.”
‘A Big Ethical Question’
Dr. Shimi Barda and Dr. Noga Fuchs Weizman have conducted dozens of posthumous sperm retrievals since the beginning of the war. They work at Tel Aviv’s Sourasky Medical Center, which has one of the largest sperm banks in Israel. Dr. Fuchs Weizman does the biopsy and removal of testicle tissue, and Dr. Barda retrieves and preserves the sperm. In a profession focused on reproduction, both said operating on dead bodies was wrenching. They have found themselves leaving the faces of the corpses covered and trying not to connect the procedures they do to the obituaries and photos of dead soldiers that they see in the news.
While Dr. Fuchs Weizman knows that she is bringing some comfort to grieving families, she has also wrestled with ethical unease.
“I understand that what we’re doing is amazing for the families — it helps them to deal with grief and gives them a chance of some hope and continuity — but I also grapple with the fact that we don’t know what those soldiers would have wanted,” she said. “That is a big ethical question that I find it very hard to resolve.”
A recent study indicates that many Israeli soldiers are uncomfortable with the notion of their sperm’s being preserved posthumously. Researchers at Ashkelon Academic College surveyed 600 Jewish men between 18 and 50 on the topic this year. Among 507 men with living parents, 47 percent did not want their parents to ask to posthumously freeze their sperm, while 38 percent approved. Even men in committed relationships weren’t in agreement: 37 percent opposed the idea of their partner’s asking to freeze their sperm posthumously.
The study was led by Bella Savitsky, an epidemiologist and researcher whose 21-year-old son, Jonathan, was killed during his military service at the start of the Israel-Hamas war. He died on Oct. 7, before the army had changed its protocol on sperm retrieval, but Dr. Savitsky refused to sign funeral papers until the army agreed to do a retrieval. She thought of her son’s stubborn optimism and curiosity, and wanted the possibility of seeing those traits live on in a grandchild.
“I didn’t care what Jonathan wanted,” she said. “I just knew that I wanted him to stay with me.”
By the time Dr. Savitsky was able to get legal permission, it was too late to freeze any viable sperm. Afterward, experiencing depression, she began working with the Parliament’s health committee, calling for legislation on posthumous sperm retrieval.
As she sat in meetings about the legal and ethical questions, she wondered whether her all-consuming grief had made her overlook what her son would have wished for. She has since urged the army to document before soldiers begin their military service whether they consent to posthumous sperm retrieval. She worries about whether families will use the frozen sperm to create a “living monument” to the dead.
Those calls for regulatory caution are colliding with the demands of other grieving families, which view the use of this technology as almost their wartime right.
Mr. Harush said he believed that the Israeli government was obligated to fulfill his son’s wish for children. Over the summer, while Mr. Harush cleaned out his house and prepared to move somewhere with fewer painful memories, he found his son’s diary. Scrawled in a recent entry, viewed by The New York Times, was a description of his hopes to start a family: “There’s no replacement for continuity,” the diary read.
“Reef wanted to be a father — this is for sure,” Mr. Harush said. “The country has to take responsibility.”
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