The cultural construction of motherhood represents women of low socioeconomic status as excessively fertile, placing them outside of the infertility discourse. Previous research on infertility reinforces poor women’s exclusion by focusing on the experiences of women receiving medical treatment, typically women of high SES. In this article, the author explores how 20 poor and working-class women negotiate their experiences of infertility. In-depth interviews expose the contextual experiences of infertility among women of low SES, specifically revealing (...) the structural inequality apparent within those experiences. The women are not passive objects of dominant discourses; they are active subjects in resisting, redefining, and accepting the discourses according to their contexts. Women of low SES are outsiders—within to dominant understandings and resolutions to infertility. Their unique insights not only provide a more nuanced understanding of infertility but they also begin to deconstruct the stratified system of reproduction. (shrink)

In 2012, a number of news headlines captured a growing trend in fertility medicine—the increased presence of lenders specializing in fertility loans, often promoted or featured by fertility clinics and physicians. Streamlining the financing of assisted reproduction connects patients with loan company representatives either on‐site or through a clinic's webpage. While medical professionals and clinics do not receive a commission for product promotion, this recent spate of news reports identified investment opportunities for physicians in private lending firms and some (...) of the physicians involved in such investments. In facilitating the process to obtain credit and, in some instances, benefiting financially through equity ownership in private lending firms, participating physicians declare this a “win‐win situation” with no clear conflict of interest. The emergence of these specialty lenders seems a natural development in the current fertility market, but the growing use of private fertility loans suggests the need for further inquiry. (shrink)

I explore the role that values and interests, especially ideological interests, play in managing and balancing epistemic risks in medicine. I will focus in particular on how diseases are identified and operationalized. Before we can do biomedical research on a condition, it needs to be identified as a medical condition, and it needs to be operationalized in a way that lets us identify sufferers, measure progress, and so forth. I will argue that each time we do this, we engage (...) in epistemic risk balancing that inevitably draws upon values and interests, often including social and ideological values. My main interest here is in the conceptualization of infertility as a disease. Infertility is a rich test case for exploring the interplay between interests and epistemic risk management. There is no uncontested or standardized definition of infertility. The various definitions of it are internally ambiguous and tension-ridden, and in spectacular contradiction with one another. Many interest groups who are invested in framing infertility as a pressing problem deserving of social and medical redress are quick to insist that it is a legitimate ‘disease,’ but they cannot agree on which disease it is, what its symptoms or diagnostic markers are, or even what its basic ontology is. I suggest that there are political explanations for this epistemic mess. Indeed, I contend that there are good scientific and ethical reasons to reduce away the category of ‘infertility,’ especially understood as a scientific or medical category; I argue that we should excise the concept from our research and clinical practices. (shrink)

Claims about whether or not infertility is a disease are sometimes invoked to defend or criticize the provision of state-funded treatment for infertility. In this paper, I suggest that this strategy is problematic. By exploring infertility through key approaches to disease in the philosophy of medicine, I show that there are deep theoretical disagreements regarding what subtypes of infertility qualify as diseases. Given that infertility's disease status remains unclear, one cannot uncontroversially justify or undermine its (...) claim to medical treatment by claiming that it is or is not a disease. Instead of focusing on disease status, a preferable strategy to approach the debate about state-funded treatment is to explicitly address the specific ethical considerations raised by infertility. I show how this alternative strategy can be supported by a recent theoretical framework in the philosophy of medicine, which avoids the problems associated with the concepts of health and disease. (shrink)

This article discusses the new reproductive technology of egg freezing in the context of existing literature on gender, medicalization, and infertility. What is unique about this technology is its use by women who are not currently infertile but who may anticipate a future diagnosis. This circumstance gives rise to a new ontological category of “anticipated infertility.” The author draws on participant observation and a qualitative analysis of scientific, mainstream, and marketing literature to identify and compare the representation of (...) two different candidates for egg freezing: women with cancer and healthy young women. Although both populations experience anticipated infertility, their dichotomous portrayals as appropriate candidates are demonstrative of gender norms linking women to motherhood. Egg freezing is a concise illustration of how the medicalization of women’s bodies and bodily processes masks a host of cultural anxieties about aging, illness, reproduction, and risk. (shrink)

Using qualitative data based on interviews with 22 married infertile couples living in western New York State, we describe the ways in which husbands and wives interact in the process of constructing their infertility. The wives experienced infertility as a cataclysmic role failure. Husbands tended to see infertility as a disconcerting event but not as a tragedy. Couples tended to see infertility as a problem for wives. Frustration and lack of communication were typical consequences of the (...) confrontation of husbands' and wives' perspectives on infertility. Interactions with medical professionals tended to reinforce these consequences. These interactions between wives, husbands, and medical professionals may lead to taking wrong directions in treatment and to ignoring treatment options. Some of the problems we describe could be lessened by adopting a model of couple-centered treatment in a setting that incorporated routine counseling. (shrink)

The Chief Medical Officer of Health of the United Kingdom has recommended that the 1990 Human Fertilisation and Embryology Act should be amended to allow cloning in humans for research purposes only. He also recommended that: “The transfer of an embryo created by cell nuclear replacement into the uterus of a woman (so called ‘reproductive cloning’) should remain a criminal offence” (recommendation 7, Ref. 1). This recommendation implies that nuclear replacement and cloning are the same. They are not. Nuclear (...) transfer constitutes reproductive cloning only when the individual created is genetically identical to the nuclear donor. In this paper, we describe a possible future use of nuclear transfer for the treatment of infertile individuals. The treatment yields an individual that receives approximately equal genetic contributions from each parent. We use this example to illustrate how semantic confusion might lead to plausibly moral and justifiable treatments being legally banned. In doing so, we hope to encourage a more accurate and informed use of language in science, law and politics, so that legislation is properly informed by science and achieves what it intends. BioEssays 23:359–364, 2001. © 2001 John Wiley & Sons, Inc. (shrink)

Fiction television series are one of the few cultural expressions in which men’s infertility experiences are represented. Through a content analysis of twenty fiction series, this article describes and analyzes such representations. By drawing on Connell’s concept of hegemonic masculinity and Ricoeur’s understanding of paradoxical power structuring, four character types of infertile men are identified: (1) the virile in/fertile man, (2) the secretly non-/vasectomized man, (3) the intellectual eunuch, (4) the enslaving post-apocalyptic man. While these various dramatis persona outline (...) different ways of how infertile men relate to normative hegemonic masculinity, they all represent infertile men as diverging from shared masculine norms. This non-normativity initially excludes many represented men from hegemonic positions. Eventually, however, these men generally aspire to and succeed in reaffirming their hegemonic masculinity through coercive force towards women and other men, through instigating the precondition for any power structure – the shared will to live together as a community –, and/or by seeking and finding explicit recognition for their normativity and dominance. At the end of this paper, I will reflect on the potential harmful effect of these outlined representations of infertile men and make a plea for diversifying representations of infertile men in our culture. (shrink)

In this paper we will look at the various ways in which infertility can be understood and at how need for reproductive therapies can be construed. We will do this against the background of research with artificial gametes. Having explored these questions we will attempt to establish the degree to which technologies such as AGs could expand the array of choices that people have to reproduce and/or become parents. Finally, we will examine whether and in what ways the most (...) promising developments of such technologies are likely to bring about the “end of infertility”. (shrink)

In Western countries today, a growing number of women delay motherhood until their late 30s and even 40s, as they invest time in pursuing education and career goals before starting a family. This social trend results from greater gender equality and expanded opportunities for women and is influenced by the availability of contraception and assisted reproductive technologies. However, advanced maternal age is associated with increased health risks, including infertility. While individual medical solutions such as ART and elective egg (...) freezing can promote reproductive autonomy, they entail significant risks and limitations. We thus argue that women should be better informed regarding the risks of advanced maternal age and ART, and that these individual solutions need to be supplemented by a public health approach, including policy measures that provide women with the opportunity to start a family earlier in life without sacrificing personal career goals. (shrink)

As a feminist updating of Foucauldian analysis, the article makes the point that ‘the lesbian’ was not significantly exposed or seriously interpellated by Danish official discourse until the political debate on new reproductive technologies and reprogenetics accelerated at the end of the 20th century. In the 1990s, the debate thus constructed ‘the lesbian’ not only as an ‘unnatural mother’, but also as heiress to the monstrous figure of the ‘mad scientist’ whose tampering with the embryo had stirred the political mind (...) in the previous decade. Deeply worried by developments in biotechnology, many politicians felt they should protect the embryo from this sinister scientist, and, subsequently, the innocent child from the monstrous lesbian. Hence, a majority of MPs voted for excluding lesbians and single women from access to assisted reproduction in medical clinics. (shrink)

Despite establishing the gendered construction of infertility, most research on the subject has not examined how individuals with such reproductive difficulty negotiate their own sense of gender. I explore this gap through 58 interviews with women who are medically infertile and involuntarily childless. In studying how women achieve their gender, I reveal the importance of the body to such construction. For the participants, there is not just a motherhood mandate in the United States, but a fertility mandate—women are not (...) just supposed to mother, they are supposed to procreate. Given this understanding, participants maintain their gender by denying their infertile status. They do so through reliance on essentialist notions, using their bodies as a means of constructing a gendered sense of self. Using the tenets of transgender theory, this study not only informs our understanding of infertility, but also our broader understanding of the relationship between gender, identity, and the body, exposing how individuals negotiate their gender through physical as well as institutional and social constraints. (shrink)

This article will examine current US health insurance policies for providing fertility services and Assisted Reproductive Technologies and analyze the open-ended policies of the Commonwealth of Massachusetts. This state in particular will be discussed in depth, as there are virtually no limits on infertility provision or coverage. However, tightening up Massachusetts’s health insurance policies by putting parameters on provision and coverage of Assisted Reproductive Technologies will allow the infertile to continue to access paid-for treatment while ensuring that the goal (...) of health insurance coverage—which I understand to be the provision of paid coverage to address medical conditions—is maintained. (shrink)

Infertility Accepted treatment is replete with bioethical dilemmas regarding the limits of available medical therapies. Poland has no legal acts regulating the ethical problems associated with infertility treatment and work on such legislation has been in progress for a long time, arousing very intense emotions in Polish society. The purpose of the present study was to find out what Polish women undergoing infertility treatment think about the most disputable and controversial bioethical problems of assisted reproduction. An (...) Attitudes towards Bioethical Problems of Infertility Scale was constructed specifically for this study. Items were taken from the Bioethics Bills currently under discussion in Polish Parliament (Seym). 312 women were enrolled in the study. Women experiencing infertility favoured more liberal legislation. Participants disagreed, for example, with the following regulations: prohibition of embryo freezing, prohibition of preimplantation genetic diagnosis of embryos, age limits for women using in vitro fertilisation and prohibition of in vitro fertilisation for single women. The opinions of patients undergoing infertility treatment are an important voice in the Polish debate on the Bioethics Bills. (shrink)

In this article, it is argued that it is problematic to construe the debate around the process labelled ‘surrogacy’ as a form for infertility treatment. Firstly, this way of defining what happens opens up a new form of medical desire where a growing number of people wish to have children through ‘surrogacy’. This medicalizes childlessness and creates pressure within health services to respond to the desires of an ever-growing group of patients. Secondly, this labels the woman who carries (...) the child as a ‘surrogate’ and defines her as a core element in a ‘treatment method’. This way of phrasing and defining what happens puts the woman carrying the child in an unacceptable moral position within the health system. Thirdly, by viewing the woman carrying the child as a ‘substitute’ for a mother or as a ‘temporary custodian’ ignores the unique relationship between the foetus and the pregnant woman. To keep the ethical issues in focus in the ‘surrogacy’ process, it is necessary for health professionals to always... (shrink)

Background Infertility is an increasingly prevalent disease in society and is considered by the World Health Organization to be a public health problem. An important ethical issue arises from the clarification of reproductive rights in a fair and equal way. The objective of this study was to deepen and update the knowledge and discussion about the difficulty of accessing infertility treatments in Brazil. Methods A cross-sectional observational study was carried out through the application of an online questionnaire that (...) collected the socioeconomic characteristics of couples and identify how barriers to infertility care affect the most vulnerable populations. We included couples who sought medical assistance to achieve pregnancy at two clinics in the states of São Paulo and Minas Gerais. Results A total of 201 questionnaires were analyzed. Most couples self-declared as white and the average age of wives was 36 years and husbands 38 years. 65% (65%) of couples would proceed with the treatment in a different city to which they lived, 37% evaluated as having easy access to a medical specialist only after indication, and more than half of the participating have thought about giving up the treatment due to some difficulty in accessing it. 39% of participants sought more than one medical service to find better reception, 42% of couples sought more than one medical service to define where it would be better financially, and 67.2% referred to the high cost of treatments, that is, financial issues, as a great difficulty in accessing medical services and/or treatment. Although 72.6% of couples considered having a good quality of life, 54.2% admitted that infertility and the search for treatment generated anxiety/stress in the couple’s life. Conclusion There is a need for public education on reproductive health and for policymakers to raise awareness of the importance of the difficulty that many couples face in seeking treatment to become pregnant, especially in countries with less financial resources. Indeed, it is commonly accepted that there is a universal human right to access healthcare of appropriate quality as a matter of justice. Discussion of access to reproductive technologies should be considered taking into account the longstanding ethical debate regarding fertility, fecundity, and infertility, as well as reproductive care. (shrink)

This paper investigates the gendered and racialized discourse on Polycystic Ovary Syndrome in India. A complex metabolic, endocrinal and reproductive disorder, PCOS is one of the most common endocrinopathies in women of reproductive age today. Due to an unclear etiology, there is no single clinical definition for PCOS, contributing to a sense of confusion around the syndrome. India has one of the highest rates of PCOS in the world. Medical and social discourses on PCOS suggest the high rates are (...) due to the failures of Westernized lifestyle and diet in women from developing countries. Taking the example of India, I argue that the lack of a clear etiology creates a discursive vacuum and that PCOS in itself is not a gendered and racialized syndrome, but the discourse on it is. Through the figure of the “new Indian woman,” I address the socio-political anxieties of nationalism projected onto the female body and suggest that the discourse on PCOS in India is in reaction to a rising nationalist rhetoric. As a syndrome that presents through “masculine” symptoms, PCOS acts a unique entryway into the intersectional issues of gender, race, sexuality, class and national identities. An analysis of the Indian setting might shed light on PCOS discourses that are increasingly relevant globally. (shrink)

Australian law affirms a binary construction of fertility/infertility. This model is based upon the medical categorization of infertility as a disease. Law supports medicine in prioritizing technology, such as in vitro fertilization, as treatment for infertility. This prioritization of a medico-legal model of infertility in turn marginalizes alternative means of family creation such as adoption, fostering, traditional surrogacy, and childlessness. This paper argues that this binary model masks the impact of medicalization upon reproductive choice and (...) limits opportunity for infertile individuals to create families. While medical technology should be available to enhance reproductive opportunity, infertile individuals will benefit from regulatory change which disentangles the medico-legal construct of infertility as a disease from the desire to create a family. This paper suggests that the medico-legal model of infertility should be reframed to support all opportunities for family creation equally, including non-medical opportunities such as adoption, fostering, and childlessness. (shrink)

Medical science is advancing all the time. Researchers are constantly trying to find new ways to help people to have long and healthy lives. Thanks to their work, doctors today can cure diseases, lessen pain, replace unhealthy limbs or organs, and help infertile couples have children. Doctors can even keep seriously ill people alive against all odds. But not everyone is enamored with advances in medicine. They question whether it is appropriate to prolong life in all cases, or believe (...) that certain treatments have been developed unethically. This book looks at how the ways that doctors treat the sick are developed, and examines some of the questions that are raised by advances in medical science. (shrink)

L’aide médicale à la procréation avec tiers donneur ( amp-d ) est un processus médical qui permet à des hommes infertiles de devenir père grâce à un don de sperme. À partir du récit rétrospectif du parcours d’ amp-d de M. au cours d’un entretien de recherche, l’article étudie des représentations psychiques et des fantasmes liés à ce don. Au croisement du biologique et du psychique, du conscient et de l’inconscient, il explore ces paroles subjectives en les articulant à celles (...) d’autres patients, à des références biomédicales et à des théories scientifiques sur le rôle de l’homme dans la procréation, pour voir comment ces productions psychiques accompagnent l’homme infertile dans son devenir père d’un enfant conçu par don. (shrink)

In the medical-technological practice of in vitro fertilization, it is increasingly the couple, rather than an individual patient, that is considered the unit of treatment. This article traces some mechanisms involved in the construction of medical interventions on female bodies as appropriate and effective therapeutic solutions to problems and diagnoses pertaining to male bodies. It traces the transformation of male infertility through shifts in localization and definition of the problem, concomitant reconceptualizations of the techniques involved, redistributions of (...) properties, and specific ways of constructing "success. " It is argued that both the notion of the couple as the patient in cases of male infertility and the claim that IVF techniques are appropriate solutions to this couple's problem simultaneously presuppose and legitimize medical interventions on women's bodies. This double movement is produced by leaving exactly the required material work of physical interventions—and, consequently, the uneven distribution of costs between the sexes—out of scientific accounts of these practices. (shrink)

Reality TV is immensely popular, and various shows in this media genre involve a storyline of infertility and infertility treatment. Feminists argue that normative and constructed realities about infertility and infertility treatment, like those in reality TV, are central to the emancipation of women. Such realities are able to steer viewers' perceptions of the world. This article examines the emancipatory significance of representations of women on 'infertility reality TV shows'. While the women in these shows (...) all have 'abnormal' qualities, we consider their portrayal as figurations of monstrosity. In the literature, monstrosity is understood as a way to challenge nonemancipatory norms by offering an alternative identity. Through a content analysis of seven reality TV shows, we identified four types of in/fertile monsters: the cyborg, the freak, the abject, and the childless. We show that these monsters are predominantly non-emancipatory as they all involve mechanisms of altering, excluding, or condemning infertility in relation to what is considered normal and acceptable womanhood. Therefore, at the end of this article, we make a plea for more diverse and emancipatory representations of infertile women in popular culture. (shrink)

Interest in the future, clinical implementation of uterus transplantation for uterine factor infertility was recently boosted by the demonstration of proof-of-concept for deceased uterus donation/transplantation. The ethical dimensions of living and deceased uterus transplantation are explored and addressed in the paper through their comparison to the ethical elements of an existing, legal, assisted reproduction practice in some high-income countries, i.e., gestational surrogacy. A set of six ethics lenses is used in the comparative analysis: reproductive autonomy and rights, informed choice/consent, (...) relevant critical relational theories, health equity, theoretical application of the accepted living donation standard, and comparative benefits and burdens considerations. Gestational surrogacy, as currently practiced in some high-income countries, is the assumed, theoretical base-threshold for determination of ethical acceptability in assisted reproduction practices. The analysis demonstrates that : 1) the ethical acceptability of living uterus donation/transplantation is less than that of gestational surrogacy in high-income countries, and 2) the ethical acceptability of deceased uterus donation/transplantation is roughly equivalent to that of gestational surrogacy. This leads to the conclusion that, at the present time, only one version of uterus transplantation practice, i.e., deceased uterus transplantation, should be considered ethically acceptable for possible clinical implementation in high-income countries. (shrink)

This paper explores the reasons why women who are themselves fertile might consent to undergo in vitro fertilization (IVF) with an infertile male partner. The reasons often given are desire to have that particular man's child, or altruism, giving a gift to the partner. Although ethically, the decision should be completely woman's prerogative, because IVF programs usually treat the couple as a unit, she may be offered few other options by the medical staff. In social terms, whether the woman (...) is or is not infertile may be immaterial because in either situation, if she wants to try to have a biological child and maintain the relationship, she may have to make a patriarchal bargain and undergo in vitro fertilization. (shrink)

Infertility treatment is a speciality that has attracted considerable attention both from the public and bioethicists. The focus of this attention has mainly been on the dramatic dilemmas created by theses technologies. Relatively little is known, however, about how clinicians approach and resolve ethical issues on an everyday basis. The central aim of this study is to gain insight into these neglected aspects of practice. It was found that, for the clinicians, the process by which ethical decisions were made (...) was of key importance. It will be argued that this focus on the process of decision-making is more than just empty proceduralism but is based on and facilitates certain substantive ethical principles. In conclusion, suggestions as to how ethical decision-making processes can be supported and improved in infertility practice will be made. (shrink)

The purpose of this article is to ascertain and appraise the ethical issues inherent to the utilisation of preimplantation genetic diagnosis for gender selection in infertile patients anticipating undergoing a medically indicated assisted reproductive technique procedure. Performance of preimplantation genetic diagnosis per request specifically for gender selection by an infertile couple undergoing medically indicated assisted reproductive technique may not breach the principles of ethics, and is unlikely to alter the population balance of sexes.

The risks associated with the techniques of medically assisted procreation (MAP) rapidly became well-known, and in such a short space of time that no biomedical domain remained untouched by the great deal of thinking and the expression of a multitude of opinions it provoked. MAP is evolving between two poles: quality/misuse (even violation) and evidence/fantasy. The ethics will be evoked in the clinical reality from which they spring and where their justification lies. The three objects common to these ethics, the (...) oocyte, the embryo and the child, are illustrated in this context. MAP has as its corollary access to the oocyte, the fertilization of which will take place in vitro. Access to the embryo, on the other hand, enables the clinician, for the purposes of diagnosis [preimplantation genetic diagnosis (PGD), predictive medicine], or even soon for therapeutic purposes (gene therapy) to draw close to a boundary, to trespass beyond which may be seen by humanity to threaten its very origins and integrity: the alienation of the human genome. For the infertile couple, the missing child may take on a dimension of which they would have been unaware, had they not been forced to express their desire. The burden of the imaginary child may, in this way, become a heavier load to bear when, after such desire, he comes into being. MAP puts the goal of normalisation within reach and, in doing so, accentuates the risk of the burden of the attributed representation of the child. On the one hand, MAP offers a tremendous diagnostic and therapeutic potential, while on the other it opens the door to excess and delirium. In this melting pot, ethics, catalysed by this new source of problematics, has discovered a favourite area in which to define and redefine itself. We propose the intervention of ethics on three different levels. Before the elaboration of the law: on first reflection, ethics may influence the responsibilities of the legislator, by taking care that the law does not obscure the biomedical and socioeconomic contexts of MAP and, thereby, also include other related and complementary aspects dealing with the same subject. The secondary discussion of ethics should influence the application of legal protection, by taking into account the rapid technological and social development of MAP, there too, by discussing the whole, rather than the details which will obscure the object. The ethical reflection of the clinician, who is aware of these difficulties, is guided by elements that are specific to his position as a doctor. The cohesion of the team around the clinician and the ethics specialist enables us to develop consensual clinical ethics that are transmissible and therefore teachable. This complex role can, in our view, only be acted out directly in the clinical situation, where the constant, direct relationship with the object of the reflection and the treatment allows ethics to take into account the contingencies of medical practice: we invite the ethics specialist to take part in our clinical activity on a daily basis. (shrink)

In the United States, single individuals and LGBTQ couples who wish to conceive biological children are considered to be “socially infertile” due to their relationship status. Due to the high cost of infertility treatments and inadequate insurance coverage, the socially infertile has minimal access to assisted reproductive technology. Under the current medical definitions of infertility, even in states with infertility insurance mandates, only heterosexual couples with physiological infertility are covered for ART. It is well documented (...) that infertility interferes with many aspects of the human experience and reduces the quality of life for involuntarily childless individuals regardless of whether the infertility is physiologically or socially based. Physiological infertility was initially considered to be a private issue before being recognized as a medical diagnosis and has since legitimized heterosexual couples’ access to ARTs. The medical diagnosis of infertility not only affirms that their intention to conceive biological children is justifiable but also confirms that it is a condition that can and should be treated with current medical interventions. Expanding the current definition of infertility to include social infertility will elevate it to a treatable medical condition, justifying the use of ART for such individuals and potentially alleviating the negative impacts of infertility. Thus, states with infertility insurance mandates should provide the same infertility coverage to socially infertile individuals as physiologically infertile heterosexual couples. (shrink)

This paper develops previous work on theories of embodiment by drawing on empirical data from a study into the experiences of infertile women in the UK. I suggest experiences of embodiment shape the preferences of infertile women for a female nurse as chaperone during intimate medical procedures. I explore the impact of this role on the understandings and meanings of nursing in a highly gendered field of practice. I present data from an ethnographic study of infertile women who chose (...) to attend a British infertility clinic for investigation and fertility treatment cycles. Data were collected over 2 years using participant observation and semistructured interviews with 15 women and 20 members of staff in a British fertility unit. Data analysis was completed using a modified thematic analysis following Boyle and McEvoy. I discuss women's experiences of intimacy and bodily care and how these experiences might be understood by exploring the phenomenological concept of embodiment. I argue that women benefit from having a female nurse as chaperone because of their expectations of gender, nursing and caring. Women's expectations reinforce both notions of gendered caring and the gendered role of nursing. These data challenge notions of patriarchal professionalism prevalent in nursing, which seek to move away from the gendered role of the nurse (which traditionally included a chaperone role) towards a model of professional development based on a mind–body split. I suggest that these data offer a way of understanding the female embodied subject in the field of gendered caring, which is potentially transgressive because they suggest ways in which both mind and body can be integrated through the role of the female chaperone. (shrink)

The Journal of Medical Ethics has published a few papers over recent years that explore the ethical implications of ectogenesis.1–4 It is an as yet undeveloped but theoretically possible method by which a fetus can be gestated outside of the womb, and while the prospects of ‘full’ ectogenesis seem some way off, there are techniques that suggest ‘partial’ ectogenesis could be closer. This issue’s Feature Article considers two of the principal arguments that have been developed in favour of ectogenesis (...) being permissible and available.5 Cavaliere observes that the equality and freedom promoting aspects of ectogenesis will only benefit a small number of women, and she argues that it’s the broader political perspective ectogenesis advances that’s valuable. By equality she has in mind the workplace, the burdens of bearing, as well as equality among fertile, infertile, trans and lesbian women. In this context, …. (shrink)

Background/IntroductionInfertile couples that travel to another country for reproductive treatment do not refer to themselves as “reproductive tourists”. They might even be offended by this term. “Tourism” is a metaphor with hidden connotations. We will analyze these connotations in public media discourses on “reproductive tourism” in Israel and Germany. We chose to focus on these two countries since legal, ethical and religious restrictions give couples a similar motivation to travel for reproductive care, while the cultural backgrounds and conceptions of reproduction (...) are different. Results: Our research shows that the use of the metaphor “reproductive treatment” and its hidden messages depends on the writers’ intention and the target population. Although the phenomenon of patients travelling for reproductive treatment can fit into the definitions of tourism, the term emphasizes aspects that do not reflect patients’ reality. In both the German and the Israeli public media debate the term “reproductive tourism” is either used to criticize the economic aspects of the phenomenon or to attract patients as potential clients. Conclusions: Ethicists should be cautious when borrowing metaphors like “reproductive tourism” from the public debate. Our findings support Penning’s suggestion to use instead an unloaded term like cross-border reproductive care to describe the phenomenon in a more neutral way and to make it explicit whenever criticism is necessary. (shrink)

Mitochondrial replacement techniques (MRTs) usually aim to prevent the genetic transmission of maternally inherited mitochondrial diseases. Until now, only the UK and Australia have implemented specific legal regulations of MRTs. In both countries, clinical trials on these techniques are only permissible for cases with a high risk of severe mitochondrial disease in the offspring. However, these techniques can also be applied to treat infertility, especially for older women with impaired oocyte quality. In some countries without legal regulation of these (...) techniques, MRTs are already offered for this purpose. Yet, this application of MRTs has received insufficient attention in the bioethical literature so far.In this paper, I examine whether there are ethical reasons to prohibit trials on MRTs in the context of infertility when they are permitted for preventing mitochondrial disease. Allowing MRTs in one context but not the other might be justified either because their application in the context of mitochondrial disease (1) is supported by a more convincing evidence base, (2) has a higher potential benefit or (3) has a lower risk. I compare both applications of MRTs with respect to these three factors. I conclude that there is no convincing reason to prohibit clinical trials on MRTs for infertility when they are permitted in the context of mitochondrial disease. (shrink)

BackgroundEgg donor agencies are increasingly being used as part of IVF in the US, but are essentially unregulated, posing critical ethical and policy questions concerning how providers view and use them, and what the implications might be.MethodsThirty-seven in-depth interviews of approximately 1 h were conducted – with 27 IVF providers and 10 patients.ResultsClinicians vary in their views and interactions concerning egg donor agencies, ranging widely in whether and how often they use agencies. Agencies may offer egg recipients increased choices, but (...) raise ethical and other concerns regarding respect for donors as individuals, potential harms, justice, and donors constituting a vulnerable group. The quality of agencies appears to vary considerably, from acceptable to problematic. Agencies’ medical and psychological screenings of donors can range, and be minimal. Not all agencies adequately track donors’ prior numbers of donations, or share the relevant records with clinics. Clinics may find that potential donors have genetic mutations and medical problems about which they were unaware. Yet agencies and clinics do not provide care for such donors, generating stress. Dissemination of donors’ personal data can potentially threaten confidentiality. Questions emerge of whether increased monitoring/oversight of agencies may be beneficial.ConclusionsThese data, the first to examine providers’ views and interactions regarding egg donor agencies, suggest wide variations in quality and use of agencies, and have critical implications for practice, policy, education and research. Given the potential limitations of the current model of self-regulation of agencies, the present data suggest needs to consider stronger professional guidelines or possible governmental regulations to establish, require and enforce higher standards for agencies to follow, regarding advertising to potential donors and recipients, arranging for appropriate informed consent concerning risks and benefits involved, and for quality control. Appropriate informed consent should be obtained from potential egg donors, including the fact that they may learn about mutations or medical problems about which they were unaware, but for which they will not receive treatment as part of this process. Enhancing understanding among the public-at-large about what egg donation entails may also be helpful. (shrink)

In this paper I will discuss three areas in which advances in human reproductive technology could occur, their uses and abuses, and their effects on society. First is the potential to drastically increase the success rate and availability of in vitro fertilization and embryo freezing. Second is the ability to perform biopsies on embryos prior to the onset of pregnancy. Finally, I will consider the adding or altering of genes in embryos, commonly referred to as genetic engineering.As new reproductive technologies (...) pass from experimental models into the potential for medical utilization, I believe that it will be important for lawmakers everywhere to avoid the impulse to outlaw procedures that a society believes to be unnatural at a first glance. Rather, I would hope that they can respond thoughtfully with legislation that serves two purposes — to protect the rights of couples to overcome infertility or to reduce the risk of genetic disease in their children-to-be, and more importantly, to protect children-to-be from the abuses that could result from some of the practices that I will discuss. (shrink)

The purpose of this article is to ascertain and appraise the ethical issues inherent to the utilisation of preimplantation genetic diagnosis for gender selection in infertile patients anticipating undergoing a medically indicated assisted reproductive technique procedure. Performance of preimplantation genetic diagnosis per request specifically for gender selection by an infertile couple undergoing medically indicated assisted reproductive technique may not breach the principles of ethics, and is unlikely to alter the population balance of sexes.

Effective July 22, 2011, a new law in the state of Washington requires any donor of sperm or eggs to provide a medical history and identifying information to fertility clinics. It also allows donor‐conceived individuals to request this information from clinics once they reach the age of eighteen. This is a significant legislative milestone and a promising development in a country that has consistently shied away from regulating the infertility industry in any way. What do we as a (...) society owe donor‐conceived individuals in terms of obtaining access to information about their genetic origins? This essay addresses just one of this set of issues: the regulatory changes required to address the medical interests of donor‐conceived individuals, regardless of whether a human right to know one's genetic origins is acknowledged. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Morality in Flux: Medical Ethics Dilemmas in the People's Republic of ChinaRen-Zong Qiu (bio)IntroductionModern China is undergoing a fundamental change from a monolithic society to a rather pluralistic one. It is a long and winding road. Marxism is facing various challenges as the influence of Western culture increases. Confucianism is still deeply entrenched in the Chinese mind but various religions, including Buddhism, Islam, and Christianity are experiencing a (...) revival. Almost fifty minorities coexist in the country in addition to the majority Han people. Tension and conflict are inevitable as diverse—and sometimes incompatible—values come to the fore at this historic juncture. Many fields, including medicine, face new challenges, and in this environment the field of bioethics is flourishing.Like many countries, China is groping with the effects of new medical technology and skyrocketing health care costs. But in the context of the Chinese sociocultural environment, some unique—as well as more familiar—issues arise. None of the classic texts provide ready-made answers to these dilemmas; we must find the answers ourselves. The only reasonable way to resolve the conflicts between opposing values is through dialogue, consultation, and negotiation among the various social and cultural groups.The bioethical dilemmas receiving the most attention in China now relate to the two ends of life: birth and death. On one end are issues relating to reproductive technology, especially birth control and family planning; at the other end is euthanasia.Dilemmas Surrounding Reproductive TechnologyAccording to traditional Chinese belief, not having a child results from not having virtue. In fact, the most serious violation of the Confucian [End Page 16]principle of filial piety is to be without offspring. A Chinese man without a child experiences heavy psychological pressure, and the burden is especially onerous for women because infertility is always blamed on the wife. Wives who do not bear a child are stigmatized and mistreated—even abused—in families that stick to traditional values.In China today, this widely held belief is colliding with another reality: an apparent increase in infertility among newly-married couples. The rate may be about 5 percent. These couples turn to doctors for help.Artificial insemination by donor (AID) and by husband is now widely practiced. Eleven provinces have established sperm banks, and private doctors are performing AID for considerable fees. But procedures to address legal and ethical problems associated with the procedure have lagged behind. With the exception of a few centers in large cities, AID is undertaken without established procedures or policies relating to the selection of donors and recipients, records about those involved, or clarification of the status of the child. The legal status of the child remains unresolved.The status of the child within the community is also unresolved as traditional values clash with the application of modern technology to childbearing. The case of "The Child Who Did Not Belong" (see box), illustrates how an AID child is not accepted by the family that embraces traditional values because he is not the husband's biological child.In vitro fertilization (IVF) is another alternative. Two IVF centers are in operation, one in Beijing and the other in Changsha, and both have succeeded in producing live births. This technology has received considerable media attention and is generally accepted even among those with traditional views.But much of this medical technology is not widely accessible—especially in rural areas—and so some infertile couples resort to surrogate motherhood to ensure an heir. An infertile couple enters into a contract with a woman who has intercourse with the husband in order to bear a child for the couple. This practice is called "borrowing a wife." In some villages, the "borrowed wife" receives as much as 10,000 yuan (five times a professor's monthly salary or about $250) for a girl and double that for a boy.But the more common and thorny problems involved with the beginning of life relate to birth control, family planning, and the "one couple, one child" policy that the Chinese government instituted to curb overpopulation. The goal of that policy is to prevent China's population from exceeding 1.2 billion in the year 2000... (shrink)

Medical ethics and medical practice -- Public health and the state-patient relationship -- Health rights and obligations in the European Union -- Consent to treatment -- Liability for medical injury -- Medical confidentiality -- Genetic information and the law -- The management of infertility and childlessness -- The control of fertility -- Civil and criminal liability in reproductive medicine -- Health resources and dilemmas in treatment -- Treatment of the aged -- Mental health and human (...) rights -- The body as property -- Medical futility -- The diagnosis of death -- The donation of organs and transplantation -- Euthanasia and assistance in dying -- Biomedical human research and experimentation -- Research on children, fetuses and embryos. (shrink)

As a nexus of fertility’s finitude and female midlife, menopause is a physical and cultural phenomenon through which the relation between the medicalization of the female reproductive cycle and normative attitudes toward aging become expressed. Age, like other systems of separation, can function as an “instrument of regulatory regimes” and shows similarities to gender in its body-bound, surface-focused, and morally coded position in the sociomedical sphere. However, although age is an influential social category, its reliance on historical and epistemic constructions (...) of the body has not been politicized to a degree comparable to other categories like gender, race, and sexuality. As Kathleen. (shrink)

BackgroundPrevious studies have found that the decision-making process for stored unused frozen embryos involves much emotional burden influenced by socio-cultural factors. This study aims to ascertain how Japanese patients make a decision on the fate of their frozen embryos: whether to continue storage discard or donate to research.MethodsTen Japanese women who continued storage, 5 who discarded and 16 who donated to research were recruited from our infertility clinic. Tape-recorded interviews were transcribed and analyzed for emergent themes.ResultsA model of patients’ (...) decision-making processes for the fate of frozen embryos was developed, with a common emergent theme, “coming to terms with infertility” resulting in either acceptance or postponing acceptance of their infertility. The model consisted of 5 steps: 1) the embryo-transfer moratorium was sustained, 2) the “Mottainai”- embryo and having another child were considered; 3) cost reasonability was taken into account; 4) partner’s opinion was confirmed to finally decide whether to continue or discontinue storage. Those discontinuing, then contemplated 5): the effect of donation. Great emotional conflict was expressed in the theme, steps 2, 4, and 5.ConclusionsPatients’ 5 step decision-making process for the fate of frozen embryos was profoundly affected by various Japanese cultural values and moral standards. At the end of their decision, patients used culturally inherent values and standards to come to terms with their infertility. While there is much philosophical discussion on the moral status of the embryo worldwide, this study, with actual views of patients who own them, will make a significant contribution to empirical ethics from the practical viewpoint. (shrink)

One of the goals of medicine is to improve well-being, in line with the principle of beneficence. Likewise, scientists claim that the goal of human embryonic stem cell research is to find treatments for diseases. In hESC research, stem cells are harvested from a 5-day-old embryo. Surplus embryos from infertility treatments or embryos created for the sole purpose of harvesting stem cells are used in the research, and in the process the embryos get destroyed. The use of human embryos (...) for research purpose raises ethical concern. In this context, the religious leaders play the role to be the moral compass and “reality check” to engage with the public. In Malaysia, the Ministry of Health has outlined the Guidelines for Stem Cell Research and Therapy, reflecting on Islamic principles. Since there has not been much focus on the viewpoints of other faiths in Malaysia, this study attempts to explore the ethical guiding principles deliberated by religious leaders from the Buddhist, Hindu and Catholic traditions and identify if there is a common ground between the mainstream religious views and principles of medical ethics, in relation to hESC research. Eleven religious leaders representing the Buddhist, Hindu and Catholic traditions were interviewed. Interestingly, though reasoning of religious leaders came from different angles, their underlying concerns revolve around the values of “do no harm” and “intention to save lives”. These values are also the key principles in medical ethics. The findings are applied to answer the question as to whether religious and medical guiding principles can co-exist and complement in ethical decision-making, without compromising the values. (shrink)

This is a retrospective of surrogacy in Israel in the context of medically assisted reproduction. The practice of surrogacy emerged in the 1980s, suggesting a radical view of women as autonomous reproductive agents free from double standards of patriarchy. In 1995 Israel enacted a law that regulated domestic surrogacy for the benefit of infertile married women in accord with orthodox views of halakha. In recent years we see the growth of inter-country practices catering to otherwise ineligible intended parents, and a (...) demand for posthumous male reproduction. Meanwhile, women become objects of intrusive medical procedures and commodities of a global market, more often than not for the benefit of others rather than themselves. Yet the essence of human reproduction remains relational, and calls for care and responsibility. (shrink)

Whether its title, ύπέρ τοῦ μ γεννᾶν is authentic or not, the work transmitted as ‘Book X’ of Aristotle's History of Animals deals with a wide range of possible causes for failure to conceive and generate offspring. It sets out by saying that these causes may lie in both partners or in either of them, but in the sequel the author devotes most of his attention to problems of the female body. Thus he discusses the state of the uterus, the (...) occurrence and modalities of menstruation, the condition and position of the mouth of the uterus, the emission of fluid during sleep , physical weakness or vigour on awakening after this nocturnal emission, the occurrence of flatulence in the uterus and the ability to discharge this, moistness or dryness of the uterus, wind-pregnancy, and spasms in the uterus. Then he briefly considers the possibility that the cause of infertility lies with the male, but this is disposed of in one sentence: if you want to find out whether the man is to blame, the author says, just let him have intercourse with another woman and see whether that produces a satisfactory result . The writer also acknowledges that the problem may lie in a failure of two otherwise healthy partners to match sexually, or as he puts it, to ‘run at the same pace’ ἲσοδρομῆσαι during intercourse, but he does not go into this possibility at great length , and he proceeds to discuss further particulars on the female side. (shrink)

In the USA, one child in 285 children is diagnosed with cancer every year, but thanks to improvements in medicine, the survival rate has reached 80%. However, cancer treatments, such as chemotherapy and radiation, are likely to affect their fertility later in life, limiting their ability to conceive. To reduce this risk, ovarian tissue cryopreservation is a surgical procedure that allows the ovarian tissue to be retrieved and cryopreserved in order to be reimplanted back into the abdomen and restore ovarian (...) function in children who become infertile due to gonadotoxic treatments. A case study published in 2014 offered recommendations to help assess whether such a procedure should be offered to female patients who have not yet entered puberty. This paper will investigate whether, in light of more recent and updated literature, their recommendations may need to be revised. (shrink)