The release of the 2015 Ontario Health and Physical Education Curriculum has sparked considerable controversy and some parents are protesting the sexual education components of this curriculum by keeping their children home from school. The sex-ed components aim to provide students with age appropriate information about their bodies, relationships, sex, and gender. Improvements to Ontario’s sex-ed curriculum will equip students with the necessary tools for building healthy relationships, managing mental health, and exercising tolerance and respect. Research shows that sexual education is important for children’s physical and mental health. As such, criticisms of Ontario’s new curriculum are misguided and arguably grounded in the widespread social discomfort with discussing sexual topics with children.
A similar discomfort exists in the pediatric cancer context, where some health care practitioners and parents have expressed concerns about including children and adolescents in discussions about fertility preservation technologies. These technologies, such as egg, sperm, and experimental gonadal tissue freezing aim to secure the future option of genetic reproduction. In the pediatric context, decision-making about fertility preservation technologies is difficult, in part, because children cannot consent to medical interventions. Parents must act as proxy decision-makers for their children and are charged with deciding whether the use of fertility preservation technologies is in their child’s best interest.
Although children cannot consent to medical procedures, the Canadian Paediatric Society, recommends that children with partial decision-making skills be recognized as having (some degree) of authority over their own healthcare. This means that children should be involved in medical decision-making to the extent dictated by their age and maturity. Where possible, healthcare practitioners should seek children’s assent (or dissent) to medical interventions. Involving children in the decision-making process can serve as a way to respect and promote their developing autonomy. It can also help children feel a level of control during their cancer treatments.
During the assent process for fertility preservation, some information about sexual reproduction must be discussed. In the case of (post)pubescent male patients who are eligible for sperm retrieval, healthcare providers may need to discuss masturbation, which can be required for the retrieval of sperm.
Despite the potential benefits of including children in medical decision-making, discussing sexuality and reproduction is a serious hurdle to the initiation of fertility preservation discussions, including children in decision-making, and the uptake of fertility preservation technologies. Numerous studies describe a “discomfort” felt by parents, oncologists, and other healthcare professionals that discuss fertility preservation with children. Reasons for this ‘discomfort’ may include: a deficit in knowledge about fertility preservation technologies; communication gaps between parents, healthcare providers, and patients; or a lack of access to information about sex and reproduction that is balanced, accurate, and age-appropriate.
Some parents and healthcare providers have characterized this discomfort as a concern about sexualization. They fear that children who are involved in discussions about fertility preservation are at risk of being ‘sexualized’. This concern seems different than concerns about communication and access to information. So, what could this ‘risk of sexualization’ mean?
First, it might be the case that involving children in decision-making about fertility preservation could change how parents (or healthcare providers) view children. Acknowledging that children are sexual beings with reproductive potential might be disruptive to those who think of children as asexual and innocent. Parents in particular, may be worried that children will grow up too quickly if they are involved in discussions that involve content that is typically characterized as adult content.
Second, involving children in fertility preservation discussions might change the ways the children see themselves. As a result of participating in discussions about fertility preservation, a child may learn things about their own anatomy, sexuality, or reproductive potential. It is possible that children could come to see themselves as sexual beings or as having reproductive potential. Perhaps some children will come to see themselves as consumers of reproductive technologies and as having control over and responsibility for their own reproduction.
Third, some parents, or healthcare providers might be concerned that children’s involvement in fertility preservation decision-making will change children’s behaviour. Exposing children to sexual information could cause them to behave in ways that are (construed as) more sexual. This might be a particular concern for postpubescent boys who are asked to masturbate in order to produce sperm samples for freezing. For some boys, this clinical experience may be the first time that they have engaged in masturbation.
Changes to the way that parents view children, children view themselves, or how children behave are all possible consequences of involving children in fertility preservation discussions. However, these changes are neither inevitable nor inherently problematic.
The controversy surrounding Ontario’s new sex-ed curriculum can provide some lessons for discussions about pediatric fertility preservation. To begin with, there is widespread misinformation about the Ontario curriculum. Physicians and other healthcare providers should ensure that they have access to balanced and accurate information. Also, the sexual information in this Ontario curriculum is age-appropriate and will be delivered by teachers who are trained to share this information with students. The same should be true for the disclosure of information about fertility preservation. Finally, the guidelines and expectations set out in the Ontario curriculum speak to the current social context around sex and gender and aim to build children’s skills for managing these issues. The disclosure of information within fertility preservation discussions can help children to understand their medical treatment and help them to build some of the necessary skills for coping with cancer and (in)fertility.
Social context mediates how we understand children’s involvement in fertility preservation discussions. Fortunately, improved sexual education programs can help to alleviate some of the ‘discomfort’ experienced by some adults when including children in the decision-making about fertility preservation technologies. Ultimately, giving children balanced, accurate, and age-appropriate information about sex and reproduction is in their best interest.
Angel Petropanagos is a postdoctoral fellow at Novel Tech Ethics. She completed her Ph.D. in Philosophy at the University of Western Ontario, with specializations in feminist philosophy and bioethics. Most generally, Angel’s research focuses on the ethical issues that arise in assisted reproduction and other family-building practices. Her current research projects examine the ethics of fertility preservation technologies for adults, adolescents, and children. She is also interested in age-related (social) egg freezing. In general, her work examines the various ways that social values, norms, and power relations can shape medical practices.