Abstract

Having children is a deeply meaningful human undertaking, and infertility therefore often prompts a devastating life crisis. I argue that new reproductive technologies such as in vitro fertilization are an inadequate and morally problematic response to this distress. Using a feminist phenomenological approach, I articulate the experiences of infertility patients as revealed in multi-disciplinary literature, extensive clinical observations, and interviews with patients, counselors, and clinicians. Clinical problems include negative imagery of women, low success rates, and inadequate research into risks. More fundamentally, infertility's primary distress is psychosocial rather than physical: a social stigma against childlessness creates and intensifies feelings of isolation, anger, guilt, grief, abnormality, loss of control, and challenges to sexuality, self-image and self-worth. These problems are more severe for women. A child often does not relieve these problems of infertility, NRTs cannot address psychological or social distress, and we provide few alternatives for relief. I argue that an intense desire to have children is not biologically motivated, but that the "child-wish" is part of one's self-image and life plan that developed in childhood; social norms thus contribute to the crisis of infertility and dictate the limited--primarily medical--options for resolving it. I argue that there is no obligation to procreate, making the stigma and shame of infertility misplaced. Rights to reproduce and rights to form agreements for reproductive assistance--the most common justifications for NRTs--do not safeguard the interests of potential children, challenge the social norms that cause distress for infertility patients, question undermining clinical practices, or promote genuine autonomy or relief for infertile women. I propose framing reproductive choices from an interpersonal moral point of view that emphasizes responses and responsibility; we are thereby encouraged to embrace infertile people and potential children as members of a community, to avoid destructive exercises of procreative power, to slow the medical treadmill, and to take moral initiative in preventing and relieving the distress of infertility through psychological support, expanded medical and non-medical options, and changed social expectations regarding fertility and gender roles.