Fertility treatment enables involuntary childless people to have genetically related children, something that, for many, is a valuable life project. In this paper, I respond to two sets of objections that have been raised against expanding state-funded fertility treatment provision for existing treatments, such as in vitro fertilisation (IVF), and against funding new treatments, such as uterine transplantation (UTx). Following McTernan, I refer to the first set of objections as the ‘one good among many’ objection. It purports that (...) it is unjustifiable for the state to prioritise the funding of the life project of becoming a parent through fertility treatment provision over the funding of other life projects that people might have. Following Lotz, I refer to the second set of objections as the ‘norm-legitimation’ objection. It maintains that the provision of costly forms of fertility treatment, such as UTx, would legitimise problematic social norms concerning genetic relatedness, reproduction and parenting, and that states should not engage in such a legitimation. In response to these objections, I defend the view that (reproductive) preferences ought to be taken more seriously when discussing fertility treatment provision and parental projects, and that not doing so can be costly, especially for women. The approach defended in this paper seeks to avoid disregarding and policing preferences and to reconcile their fulfilment with political projects aimed at improving the material and social conditions of sub-fertile people: people who, for social or biological reasons (or an intersection of the two), are unable to reproduce unassisted. (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)

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 (...) class='Hi'>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)

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)

Recent changes in access to contraceptive and infertility treatments in the state of Illinois, and across the United States more generally, have heightened class cleavages in access to reproductive health care benefits in the United States. Using data gleaned from government testimonies, public documents, and telephone interviews, the authors found that poor women have broad access to contraceptive coverage but very little access to infertility treatments, while working-and middle-class women have increasingly broad coverage of infertility treatments but spare coverage (...) of contraceptives. These findings suggest that while the extreme measures of the eugenics movement are less frequently in evidence, class differences in access to reproductive services lead to an equally dualistic, albeit unstated, fertility policy in the United States: encouraging births among working- and middle-class families and discouraging births among the poor, particularly those on Medicaid. (shrink)

The dynamics of populations of self-replicating, hierarchically structured individuals, exposedto accidents which destroy their sub-units, is analyzed mathematically, specifically with regardto the roles of redundancy and sexual repair. The following points emerge from this analysis:0 A population of individuals with redundant sub-structure has no intrinsic steady-statepoint; it tends to either zero or infinity depending on a critical accident rate α c . Increased redundancy renders populations less accident prone initially, but populationdecline is steeper if a is greater than a fixed (...) value α d . Periodic, sexual repair at system-specific intervals prevents continuous decline and stabilizesthe population insofar as it will now oscillate between two fixed population levels. The stabilizing sexual interval increases with increased complexity provided this is accom-panied by appropriate levels of redundancy. The model closely simulates the dynamics of heterosis effects. Repair fitness is a population fitness: the chance of an individual being repaired is a functionof the statistical make-up of the population as a whole at that particular period. Populationsliving at α > α c either engage in sexual repair at the appropriate time or they die out. The mathematical properties of the model illustrate mechanisms which possibly played arole in the evolution of a mortal soma in relation to sexual reproduction. (shrink)

As assisted reproductive technologies become increasingly popular, debate has intensified over the ethical justification for restricting access to ART based on various medical and non-medical factors. In 2010, the Australian state of Victoria enacted world-first legislation that denies access to ART for all patients with certain criminal or child protection histories. Patients and their partners are identified via a compulsory police and child protection check prior to commencing ART and, if found to have a previous relevant conviction or child (...) protection order, are given a “presumption against treatment.” This article reviews the legislation and identifies arguments that may be used to justify restricting access to ART for various reasons. The arguments reviewed include limitations of reproductive rights, inheriting undesirable genetic traits, distributive justice, and the welfare of the future child. We show that none of these arguments justifies restricting access to ART in the context of past criminal history. We show that a “presumption against treatment” is an unjustified infringement on reproductive freedom and that it creates various inconsistencies in current social, medical, and legal policy. We argue that a state-enforced policy of restricting access to ART based on the non-medical factor of past criminal history is an example of unjust discrimination and cannot be ethically justified, with one important exception: in cases where ART treatment may be considered futile on the basis that the parents are not expected to raise the resulting child. (shrink)

This paper investigates the efficiency of application of medical ethics principles in the practice of artificial insemination by donors in China, in a culture characterised by traditional ethical values and disapproval of AID. The paper presents the ethical approach to AID treatment as established by the Reproduction and Genetics Hospital of CITIC-Xiangya in the central southern area of China against the social ethical background of China and describes its general features. The CITIC-Xiangya Approach facilitates the implementation of ethical relations (...) between clinicians and patients participating in AID treatment procedures in Hunan-Yale. (shrink)

Assisted reproductive technology treatment tends to involve significant physical and emotional commitments that can impact maternal, infant, and family health and well-being. An in-depth understanding of experiences is necessary to provide adequate support for women and their families during pregnancy and transition to parenthood following ART treatment. The aim of this study was to explore first-time mothers’ experiences of pregnancy and transition to parenthood following successful ART treatment in Taiwan. Twelve first-time mothers who conceived and gave (...) live birth using ART treatment were purposively selected from a fertility centre in Taipei, Taiwan. Women’s experiences in pregnancy and in their transition to motherhood were explored using semi-structured in-depth interviews. All interviews were recorded, transcribed, and analysed using the Colaizzi strategy. The mothers’ accounts reflected three main themes: ‘being different from mothers who became pregnant naturally’, ‘ensuring health and safety of the foetus’, and ‘welcoming new lives with excitement’. The difference mothers felt about themselves was evident in four subthemes: becoming pregnant after a long wait, feeling vulnerable during pregnancy, relying on family’s assistance and support, and worrying about the impact of ART on health. The theme on ‘ensuring health and safety of the foetus’ encompassed three subthemes: activities to protect the unborn baby, monitoring foetal movement constantly to maintain peace of mind, and receiving foetal reduction for the sake of the pregnancy. Narratives around ‘welcoming new lives with excitement’ reflected four subthemes: overcoming hardship for worthwhile results, realising one’s life and dreams, proving to be fertile enough to give birth, and return to normal life track. Findings indicate the need for educational and psychosocial interventions to support women and their families physically and psychologically during ART treatment. The stigma related to infertility and the psychosocial support from family are aspects to consider while planning intervention programmes. (shrink)

Reproduction is broadly recognised as fundamental to human flourishing. The presumptive priority of reproductive freedom forms the predominant position in the literature, translating in the non-sexual reproductive realm as an almost inviolable right to access assisted reproductive technology (ART). This position largely condemns refusal or restriction of ART by clinicians or the state as discriminatory. In this paper, I critically analyse the moral rights individuals assert in reproductive pursuit to explore whether reproductive rights entitle hopeful (...) parents to ART. I demonstrate that none of the protected actions performed, or entitlements generated are sui generis ‘reproductive’ rights, leading to the claim that there is no such thing as a right to reproduce. Under scrutiny, the reproductive right is a far narrower and weaker rights assertion than is recognised in the literature. I argue that the predominant position is grounded in a fundamental misunderstanding of the scope and strength of reproductive claims.I also highlight a significant conceptual inconsistency in the literature. On one hand, there is broad consensus that reproductive rights are predominantly negative, yet access to fertility treatment is framed as a component of the right. This wrongly contorts the negative nature of reproductive rights into a positive claim-right to ART. I conclude that this mistakenly frames ART access as sitting within the scope of reproductive freedom. I offer a revised conceptual paradigm of reproductive rights that has important clinical and policy implications for the provision and regulation of ART. (shrink)

The predominant position in the reproductive rights literature argues that access to assisted reproductive technologies (ART) forms part of an individual’s right to reproduce. On this reasoning, refusal of treatment by clinicians (via provision) violates a hopeful parent’s reproductive right and discriminates against the infertile. I reject these views and suggest they wrongly contort what reproductive freedom entitles individuals to do and demand of others. I suggest these views find their origin, at least in part, (...) in the way we define “reproduction” itself. This paper critically analyses two widely accepted definitions of human reproduction and demonstrates that both are fundamentally flawed. While the process of reproduction includes the biological acts of begetting and bearing a child, I argue that it does not extend to include rearing. This reworked definition has little impact in the realm of sexual reproduction. However, it has significant ethical implications for the formulation and assignment of reproductive rights and responsibilities in the non-sexual realm in two important ways. First, a claim to access ART where one has an intention to rear a child (but does not beget or bear) cannot be grounded in reproductive rights. Second, lacking an intention to rear does not extinguish the reproductive rights and responsibilities for those who collaborate in the process. I conclude that clinicians collaborate in non-sexual reproduction at the point of triggering conception (begetting) and therefore have the right to refuse to be involved in non-sexual reproduction, in some instances, as do all reproductive collaborators. (shrink)

Reproductive tourism is the travelling by candidate service recipients from one institution, jurisdiction, or country where treatment is not available to another institution, jurisdiction, or country where they can obtain the kind of medically assisted reproduction they desire. The more widespread this phenomenon, the louder the call for international measures to stop these movements. Three possible solutions are discussed: internal moral pluralism, coerced conformity, and international harmonisation. The position is defended that allowing reproductive tourism is a form (...) of tolerance that prevents the frontal clash between the majority who imposes its view and the minority who claim to have a moral right to some medical service. Reproductive tourism is moral pluralism realised by moving across legal borders. As such, this pragmatic solution presupposes legal diversity. (shrink)

The power of new medical technologies, the cultural authority of physicians, and the gendered power dynamics of many patient-physician relationships can all inhibit women's reproductive freedom. Often these factors interfere with women's ability to trust themselves to choose and act in ways that are consistent with their own goals and values. In this book Carolyn McLeod introduces to the reproductive ethics literature the idea that in reproductive health care women's self-trust can be undermined in ways that threaten (...) their autonomy. Understanding the importance of self-trust for autonomy, McLeod argues, is crucial to understanding the limits on women's reproductive freedom. -/- McLeod brings feminist insights in philosophical moral psychology to reproductive ethics, and to health-care ethics more broadly. She identifies the social environments in which self-trust is formed and encouraged. She also shows how women's experiences of reproductive health care can enrich our understanding of self-trust and autonomy as philosophical concepts. The book's theoretical components are grounded in women's concrete experiences. The cases discussed, which involve miscarriage, infertility treatment, and prenatal diagnosis, show that what many women feel toward themselves in reproductive contexts is analogous to what we feel toward others when we trust or distrust them. -/- McLeod also discusses what health-care providers can do to minimize the barriers to women's self-trust in reproductive health care, and why they have a duty to do so as part of their larger duty to respect patient autonomy. (shrink)

Originally published as a French edition in 1991, and first translated into English for this Cambridge edition in 2004, in this exhaustive study Christian Bidard develops a theory of prices of production. This theory breaks down the symmetry between producers and consumers and gives more importance to reproduction rather than scarcity. In his analysis of multiple-product systems, Bidard focuses on the notion of an all-engaging system which elucidates the link with von Neumann's theory; examines the notions of sector and vertical (...) integration which make possible an elegant treatment of fixed capital; clarifies the status of the internal rate of return; proposes a general theory of rent. In the discussion of capital theory and marginal equalities or, more specifically, the treatment of exhaustible resources, Bidard compares different readings of Sraffa's work and revisits the question of relationships between classical theory and the general equilibrium theory. (shrink)

The social interface between reproductive medicine and embryonic stem cell research has been investigated in a pilot study at a large IVF clinic in central China. Methods included observation, interviews with hospital personnel, and five in-depth qualitative interviews with women who underwent IVF and who were asked for their consent to the donation of embryos for use in medical (in fact human embryonic stem cell) research. This paper reports, and discusses from an ethical perspective, the results of an analysis (...) of these interviews. The participants talked of extreme social pressure to become pregnant. Once they had a baby, ‘spare’ embryos lost practical significance due to the Chinese one-child policy. In the context of decision making about donating embryos to research, the women used the clinical distinctions between ‘good and bad quality’ embryos and also between frozen and transferred embryos, as guiding moral distinctions. In the absence of concrete information about what sort of research their embryos should be used for, the women interviewed either refused consent (for fear that the embryo would be given to another couple) or accepted, expressing motives of solidarity with other women in a similar situation. This reveals that they filled the knowledge gap with an image of research improving fertility treatment. (shrink)

We live in an era when increasing numbers of babies are conceived through assisted reproduction technologies (ART). Using a comprehensive approach, the present research seeks to contribute to the understanding of gender differences in experiencing and coping with infertility, and in dealing with ART treatment. Our sample consisted of 10 heterosexual couples aged 24 to 43 and the data were collected through semi-structured interviews. In the studied sample, gender differences existed not only in experiences of infertility, but also in (...) understanding it, and in dealing with ART treatment. Responses to stress caused by infertility were stronger in women and they also perceived this stress more intensely than men. For women the central aspect of infertility was the desire for a child, while for men it was perceived more as a socially imposed obligation to fulfill the male role. (shrink)

Human reproductive cloning has not yet resulted in any live births. There has been widespread condemnation of the practice in both the scientific world and the public sphere, and many countries explicitly outlaw the practice. Concerns about the procedure range from uncertainties about its physical safety to questions about the psychological well-being of clones. Yet, key aspects such as the philosophical implications of harm to future entities and a comparison with established reproductive technologies such as in vitro fertilisation (...) are often overlooked in discussions about HRC. Furthermore, there are people who are willing to use the technology. Several scientists have been outspoken in their intent to pursue HRC. The importance of concerns about the physical safety of children created by HRC and comparisons with concerns about the safety of IVF are discussed. A model to be used to determine when it is acceptable to use HRC and other new assisted reproductive technologies, balancing reproductive freedom and safety concerns, is proposed. Justifications underpinning potential applications of HRC are discussed, and it is determined that these are highly analogous to rationalisations used to justify IVF treatment. It is concluded that people wishing to conceive using HRC should have a prima facie negative right to do so. (shrink)

In Saks v. Franklin Covey Co., the Court of Appeals for the Second Circuit held that the American with Disabilities Act, Title VII of Civil Rights Act of 1964, the Pregnancy Discrimination Act, and New York state law do not proscribe an employer's self-insured employee health plan from excluding surgical impregnation procedures from its coverage. Although the court found that infertility qualifies as a disability under the ADA, it restricted required coverage of certain infedty treatments.Title I of the ADA prohibits (...) an employer from discriminating on the basis of disability “in regard to … fringe benefits available by virtue of employment, whether or not administered by the covered entity.” The ADA defines “disability” as “a physical or mental impairment that substantially limits one or more major life activities.” In Bragdon v. Abbott, the U.S. Supreme Court found that reproduction was a major life activity under the ADA. (shrink)

In Saks v. Franklin Covey Co., the Court of Appeals for the Second Circuit held that the American with Disabilities Act, Title VII of Civil Rights Act of 1964, the Pregnancy Discrimination Act, and New York state law do not proscribe an employer's self-insured employee health plan from excluding surgical impregnation procedures from its coverage. Although the court found that infertility qualifies as a disability under the ADA, it restricted required coverage of certain infedty treatments.Title I of the ADA prohibits (...) an employer from discriminating on the basis of disability “in regard to … fringe benefits available by virtue of employment, whether or not administered by the covered entity.” The ADA defines “disability” as “a physical or mental impairment that substantially limits one or more major life activities.” In Bragdon v. Abbott, the U.S. Supreme Court found that reproduction was a major life activity under the ADA. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Human Reproduction: Dominion and LimitsRichard A. McCormick S.J. (bio)The general struggle throughout Christian history has been to seek the proper balance between dominion and limits, intervention and nonintervention, givenness, and creativity. This struggle has worked itself out in six areas that touch human life. In this essay, I will revisit the Catholic tradition’s treatment of these in terms of dominion and limits to see whether we can discern (...) developmental patterns that might suggest an approach to issues pertaining to the sources of life (reproductive ethics) as we move into the next century.1. Abortion. The history of the treatment of abortion in the Catholic tradition is the history of an evaluation. This evaluation was somewhat muddied by [End Page 387] unclarity and inconsistency in the use of terms. Thus, some theologians distinguished three types of abortion: prevention of conception, abortion of an inanimate fetus, and abortion of an animated fetus. Others regarded all interventions into the life-giving process as homicides. Still others argued that termination of a nonanimated fetus was justified to save the life of the mother. And still others said such termination was anticipated homicide or the misuse of semen conceptum.Such unclarities and qualifications eventually vanished and produced an evaluation of fetal life that yielded to very few competing interests, what John Noonan (1970) referred to as “an almost absolute value.” There was some dominion or control, but the limits became increasingly clear and powerful.2. Individual and corporate self-defense. Augustine disallowed lethal individual or personal self-defense, but established the first elementary rules for war. Aquinas allowed both. Vitoria, Suarez, and others refined the criteria justifying war (jus ad bellum) and listed them as three: recovery of property, resistance to aggression, and vindication of injuries (injustices). Pius XII narrowed these to a single reason: national self-defense. The Challenge of Peace (NCCB 1983) moves away from the licitness of nuclear war and nuclear deterrence even for self-defense. Once again, the limits to the dominion over life in war grow stronger and more powerful even as the weapons of such dominion grow more powerful.3. Capital punishment. Over the centuries, Christian thinkers, such as Thomas Aquinas, permitted the use of capital punishment. Three justifications were proposed to found this right of the state: retribution, deterrence, and reform. In the past decades, however, these justifications have been seriously questioned. Both the American and Philippine bishops’ conferences have rejected all use of capital punishment. Most recently John Paul II (1995, n. 56, p. 709) adduces defense of society as the only possible justification for it and sees such cases as “very rare if not practically non-existent.”4. The preservation of life. The theme of a balance between dominion and limits is perhaps nowhere clearer than in the Catholic approach to life preservation. Catholic tradition does not accept our culture’s rejection of death. Rather it asserts that the facts that we are pilgrims, that Christ has overcome death and lives, and that we also will live with him yield a general value judgment on the meaning and value of life as we now live it: Life is a basic good but not an absolute one. It is basic because, as the Congregation for the Doctrine of the Faith (1980, p. 511) worded it, it is the “necessary source and condition of every human activity and of all society.” It is not absolute because there are higher goods for which life can be sacrificed—e.g., the glory of God, salvation of souls, service of one’s brethren, and the like. Thus in John (15:13): “There is no greater love than this: to lay down one’s life for one’s friends. John Paul II (1995, n. 47, p. 706) briefly summarizes this in Evangelium Vitae: “The life of the body in its earthly state is not an absolute good for the believer.” This value [End Page 388] judgment has immediate relevance for care of the ill and dying: Not all means must be used to preserve life.Thus the Catholic tradition has moved between two extremes: medico-moral optimism or vitalism (which preserves life with all means, at any cost... (shrink)

Despite the frequent invocation of ‘false hope’ and possible related moral concerns in the context of assisted reproduction technologies, a focused ethical and conceptual problematisation of this concept seems to be lacking. We argue that an invocation of ‘false hope’ only makes sense if the fulfilment of a desired outcome (eg, a successful fertility treatment) is impossible, and if it is attributed from an external perspective. The evaluation incurred by this third party may foreclose a given perspective from being (...) an object of hope. However, this evaluation is not a mere statistical calculation or observation based on probabilities but is dependent on several factors that should be acknowledgeable as morally relevant. This is important because it allows room for, and encourages, reasoned disagreement and moral negotiation. Accordingly, the object of hope itself, whether or not based on socially embedded desires or practices, can be a topic of debate. (shrink)

In this paper, we will discuss the prospect of human reproduction achieved with gametes originating from only one person. According to statements by a minority of scientists working on the generation of gametes in vitro, it may become possible to create eggs from men’s non-reproductive cells and sperm from women’s. This would enable, at least in principle, the creation of an embryo from cells obtained from only one individual: ‘solo reproduction’. We will consider what might motivate people to reproduce (...) in this way, and the implications that solo reproduction might have for ethics and policy. We suggest that such an innovation is unlikely to revolutionise reproduction and parenting. Indeed, in some respects it is less revolutionary than in vitro fertilisation as a whole. Furthermore, we show that solo reproduction with in vitro created gametes is not necessarily any more ethically problematic than gamete donation—and probably less so. Where appropriate, we draw parallels with the debate surrounding reproductive cloning. We note that solo reproduction may serve to perpetuate reductive geneticised accounts of reproduction, and that this may indeed be ethically questionable. However, in this it is not unique among other technologies of assisted reproduction, many of which focus on genetic transmission. It is for this reason that a ban on solo reproduction might be inconsistent with continuing to permit other kinds of reproduction that also bear the potential to strengthen attachment to a geneticised account of reproduction. Our claim is that there are at least as good reasons to pursue research towards enabling solo reproduction, and eventually to introduce solo reproduction as an option for fertility treatment, as there are to do so for other infertility related purposes. (shrink)

Since the decade of the 1970s, and particularly since the first successful test-tube baby in 1978, the development and use of assisted reproductive technologies have grown exponentially. Would-be parents—including those in so-called traditional male-female marriages, unmarried adults, postmenopausal women, and same-sex partnerships—who just over 20 years ago had no recourse for their fertility issues can now pursue their desires to have children with at least a partial, if not, total, genetic and/or biological relationship. Ovulation-stimulating medications, artificial insemination using the (...) sperm of a husband or unrelated donor, in vitro fertilization with embryo transfer, intracytoplasmic sperm injection, and gamete and zygote intrafallopian transfers are but a few of a host of treatment options ranging in complexity, invasiveness, and expense. And on the horizon are genetic techniques such as cloning—which was once considered “pure” science fiction but in 1997 became what some call an inevitability, with the development of mammalian cloning in the form of the now-famous Dolly the sheep. (shrink)

The Future of Human Reproduction brings together new work, by an international group of contributors from various fields and perspectives, on ethical, social, and legal issues raised by recent advances in reproductive technology. These advances have put us in a position to choose what kindsof children and parents there should be; the aim of the essays is to illuminate how we should deal with these possibilities for choice. Topics discussed include gender and race selection, genetic engineering, fertility treatment, (...) ovarian tissue transfer, and post-menopausal pregnancy. The centralfocus of the volume is the interface between reproductive choice and public regulation. (shrink)

Whilst the choice of becoming a parent in the natural way is unregulated all over Europe (and proposals of regulation raise vehement objections), most European countries have (either legal or professional) regulations imposing criteria that people must satisfy if they wish to gain access to assisted reproduction and parenting. These criteria may include relationship status, age, sexual orientation, financial stability, health, and willingness to attend parenting classes. The existence of regulations in this area is largely accepted, and the objections raised (...) usually concern the suitability of specific criteria rather than the legitimacy of imposing criteria at all. The inequality (if unsupported) could be solved by requiring both prospective natural and assisted parents to satisfy the same criteria (with some qualifications specified below) and, more importantly, to be subject to the same degree of monitoring, regardless of the way in which they became parents. Often people argue that proposals to regulate natural reproduction revive dreaded eugenic policies of the past, and that their implementation would violate some of our most cherished interests and rights: in particular the interest in becoming a parent and the right to reproduction and parenting. However, the same interests and rights are not equally safeguarded when one needs assistance to become a parent, and proposals to reduce the extent to which prospective parents requiring assistance are scrutinized are unpopular. In this paper we challenge the alleged justification of the current practices, and we show that there are serious inconsistencies in the treatment of, respectively, people who become parents naturally and people who require assistance to become parents. Thus, we propose that regulation of reproduction and parenting be revised in such a way as to eliminate the inconsistencies. (shrink)

In this paper, we are concerned with the ethical implications of the distinction between natural reproduction and reproduction that requires assistance. We argue that the current practice of enforcing regulations on the latter but not on the former means of reproduction is ethically unjustified. It is not defensible to tolerate parental ignorance or abuse in natural reproduction and subsequently in natural parenting, whilst submitting assisted reproduction and parenting to invasive scrutiny. Our proposal is to guarantee equal treatment to people (...) engaging in either form of reproduction or parenting. (shrink)

ObjectiveCancer and its treatments affect patients’ fertility potential. This study examined the prevalence of reproductive concerns and their relationship with metacognitions among Chinese young adult female cancer survivors.MethodsA total of 318 YAFCS completed an online survey from March to December 2021. Participants reported sociodemographic characteristics, reproductive concerns and metacognitions. Reproductive concerns were measured using the Reproductive Concerns after Cancer scale, and metacognitions were measured by the Short Form of Metacognitions Questionnaire. We used Pearson correlation analysis to (...) examine associations between metacognitions and reproductive concerns across multiple domains and multivariable linear regression to determine the influencing factors of reproductive concerns.ResultsThe mean score of reproductive concern among YAFCS was 49.97 ± 12.52. A total of 57.9% of participants reported a high level of concern regarding at least one dimension of reproductive concerns, and they were most concerned about their child’s health and least concerned about partner disclosure of fertility status. We also found a moderate association between RCAC and MCQ-30 scores. In multivariate analyses, metacognitions, especially negative metacognitive beliefs had an impact on reproductive concerns among YAFCS.ConclusionHigher reproductive concerns were associated with higher metacognitions among YAFCS, especially with negative metacognitive beliefs. Oncology professionals should pay attention to assessing reproductive concerns in patients who want to have children or who have no children. Moreover, metacognitive beliefs may be an intervention target for alleviating reproductive concerns among YAFCS. (shrink)

This paper scrutinises the many ways in which ‘success’ is portrayed in representing assisted reproductive technology (ART) services and illuminates how these definitions differ from those held by participant couples. A qualitative approach informed by feminist perspectives guided this study and aimed to problematise the concept of ‘success’ by examining literature from ART clinics, government reports on ART, and by analysing narratives of couples who have accessed ART services. As many ART services have varying definitions of ‘success’ and as (...) statistics are manipulated to promote further patronage of ART services, the likelihood of ‘success’ is often overstated. This paper is concerned with the effects this promotion has on the participants. We suggest that this very mobilisation of statistical success changes the ability of those who access ART services to make productive decisions about themselves inside these treatment regimes, as the basis for decision‐making is hidden by the way numbers, objectivity and clinical reasoning operate to maintain participation in the program. In such an operation, the powerful mix of hope and technology kept participants enrolled far longer than they originally planned. Moreover, how success rates are manipulated raises ethical issues for all involved: clients, counsellors, and nursing and medical professionals. (shrink)

Policies that determine whether someone is allowed access to reproductive healthcare or not vary widely among countries, especially in their age requirements. This raises the suspicion of arbitrariness, especially because often no underlying justification is provided. In this article, we pose the question—under which circumstances is it morally acceptable to use age for policy and legislation in the first place? We start from the notion that everyone has a _conditional positive_ right to fertility treatment. Subsequently, we set off (...) to formulate a framework that helps to determine who should be excluded from treatment nonetheless. The framework’s three core elements are: choosing and ethically justifying exclusion criteria (target), determining the actual limit between in- and exclusion (cut-off), and selecting variables that help to predict the exclusion criteria via correlation (as they are not directly measurable) (proxy). This framework allows us to show that referring to age in policy and legislation is only ethically justifiable if there is a sufficiently strong correlation with a non-directly measurable exclusion criterion. Moreover, since age is only one of many predicting variables, it should therefore not be ascribed any special status. Finally, our framework may be used as an argumentative scheme to critically assess the ethical legitimacy of policies that regulate access to (fertility) treatments in general. (shrink)

Technology is “unruly” because it operates in a social context where it is shaped by institutions, organisations and individuals in ways not envisaged when it was first developed. In the UK assisted reproductive technology has developed from strictly circumscribed beginnings as a treatment for infertility within the NHS, to a service which is more often offered by commercial clinics and purchased by clients who are not necessarily infertile. The article considers the process by which assisted reproductive technology (...) has been created and developed, a process which is ideological rather than technical, and the social implications of its ever expanding use. In a society where the discourse around reproduction and family life is one of choice and acceptance of diversity of life styles, the conditions are set for further “unruliness” supported by clinicians and commercial interests. The HFEA, public consultations and media coverage tend to subscribe to the way ethical issues are framed by those interested parties, an approach that favours increased liberalisation. (shrink)

In this paper, I discuss the ethical underpinnings to the anthropological analysis of age and reproductive decline in the ‘management’ of infertility, by suggesting that assisted reproductive technologies ‘use’ age and reproductive decline to further endanger women’s bodies by subjecting it to disaggregation into parts that do not belong to them anymore. Here, the category of age becomes a malleable concept to manipulate women seeking fertility management. In ethnographic findings from two Indian ART clinics, amongst women aged (...) between 20 and 35 years visiting an IVF/art clinic in Hyderabad city in South India, and women above 50 years of age visiting an IVF/art clinic in Hisar in North India—reproductive bodies are similarly disaggregated. In case of younger women, the treatment is fixated on rescuing eggs that may be in ‘decline’, and in case of older women, the aim is to engineer a viable pregnancy. Thus, the constant focus on eggs and wombs in infertility treatment creates a body that is not only not whole but also completely without agency. Age becomes a category that has rhetorical value to ‘push’ or persuade women into particular forms of fertility management through infertility medicine. I undertake a problematization of the egg and the uterus through the identification of the recurring motif of the menstrual cycle within IVF treatment to suggest that bodily holism is not part of ART discourse that unethically thrives on promoting technological intrusions to promote its use and normalization. (shrink)

Medical genetic interventions can be performed in two ways. First, genetic defects may be repaired (gene therapy). Secondly, a possible future individual (an embryo or a possible combination of gametes) may be preselected because of its favourable genetic make-up (by using genetic diagnostic methods and procedures from reproductive medicine so called Preimplantation Genetic Diagnosis). The first kind of intervention means that someone gets medical treatment in the normal sense, however, the second kind does not. Rather, in that case, (...) the potential patient is exchanged for another individual who is in no need of treatment. The paper explores to what extent arguments for and against these kinds of genetic intervention apply equally to all of them. For example, may the benefits that can be achieved through gene therapy be equally well achieved through genetic preselection? Are fears of a resurrection of eugenic practices through gene technology more warranted regarding therapeutic interventions than regarding preselective ones (or vice versa)? Since genetic preselection is an intervention at the germ-line level and is presently clinically applied: How is it possible to motivate that clinical application of germ-line gene therapy is not similarily permitted? (shrink)

Observing the practical situation of the techniques of assisted procreation in European societies, one is allowed to affirm that these techniques are largely in use in our societies, it did not find resistance among the secular groups of the society. It is not the case of the representatives of the Catholic church, hostile to each intervention on the reproductive mechanisms as being a violation against natural law, the most virulent opposition is linked to intervention on embryos or to each (...) way of reproduction outside of the canonic marriage, considering therefore artificial insemination as immoral and anti-juridical.The opposition between secular and the catholic groups is of unequal intensity in the different European countries, it did not stop the application and the use of these reproductive techniques although it made the adoption difficult of measures in some states, and even in the European Parliament. However, they could not oppose the scientific and medical corporation and their arguments of treatment of diseases and of sterility of men or women. This way to present these reproductive techniques in terms of lowering of suffering of couples not able to reproduce naturally received a full social acceptance and legitimation, acceptation because the origin of these techniques is incontestably scientific and legitimation because the goal is essentially medical. (shrink)

This article examines two questions pertaining to the extension of infertility treatment to postmenopausal women. First, what concepts and principles of infertility practice apply to assisted reproduction for the postmenopausal patient? Second, what role should these concepts play in the development of an ethical justification for extending women's reproductive lives past the menopausal boundary? The argument offered here supports their claim to infertility services on the basis of the formal principle of justice, which requires that similar cases be (...) treated similarly. The cases of many postmenopausal patients are argued to be relevantly similar to classes of patients who already receive assistance in reproduction. (shrink)

Potential applications of genome editing in assisted reproductive technology (ART) raise a vast array of strong opinions, emotional reactions and divergent perceptions. Acknowledging the need for caution and respecting such reactions, we observe that at least some are based on either a misunderstanding of the science or misconceptions about the content and flexibility of the existing legal frameworks. Combining medical, legal and ethical expertise, we present and discuss regulatory responses at the national, European and international levels. The discussion has (...) an EU starting point and is meant as a contribution to the general international regulatory debate. Overall, this paper concludes that gene editing technologies should not be regulated autonomously. Rather, potential uses should be regulated under general, existing frameworks and where applicable by reference to sufficiently equivalent technologies and techniques already subject to specific regulation. To be clear, we do not argue for the hasty introduction of gene editing as a reproductive treatment option in the immediate future. We call for caution with regard to overreaching moratoria and prohibitions that will also affect basic research. We recommend flexible regulations that allow for further responsible research into the potential development of the technology. We call for an open and inclusive debate and argue that scientific communication should claim a more prominent role to counter the danger of widespread misinformation. A high level of transparency and accuracy should guide scientific communication while simultaneously global‐scale responsibility and governance should be fostered by promoting cross‐disciplinary thinking and multi‐level stakeholder involvement in legal and regulatory processes. (shrink)

In recent years, as newborn screening has expanded to include conditions for which treatment is questionable, new rationales for screening have proliferated. One such rationale is the potential reproductive benefit to parents from the detection of a genetic condition or carrier status in infants. An unanticipated consequence of invoking knowledge of reproductive risk as a major benefit of screening has been to open newborn screening to the charge that it constitutes state‐sanctioned eugenics. Thus, an endeavor that had (...) been viewed as the converse of state programs of selective breeding has come to be seen in some quarters as yet another of its incarnations. The result has been serious and self‐inflected harm to the reputation of newborn screening programs. (shrink)

Global reproductive landscapes and with them cross-border routes are rapidly changing. This paper examines the reproductive routes and choices of fertility travellers from China to Russia as reported by medical professionals and fertility service providers. Providing new empirical data, it raises new ethical questions on the facilitation of cross-border reproductive travel and the commercialisation of reproductive treatment. The relaxation of the one-child policy in 2014 in China, the increasing demand for ART exceeding the capacity of (...) national fertility clinics and the difficulty of accessing treatment with donor eggs concomitant with a growing economic power of the upper–middle class are shaping the ART industry in Asia in new ways. A new development is Chinese citizens increasingly seeking ART treatment in Russia, which has a long-standing practice of ART governed by a liberal legislation. Furthermore, as China prohibits the export of gametes, Chinese fertility travellers rely on acquiring donor gametes once starting treatment abroad. Clinicians in Russia report three strategies amongst their Chinese patients: One group is using donor eggs of women of Asian appearance living in Russia or is hiring women of resembling appearance from third-party countries to donate their eggs in Russia to create resemblance in their offspring. Another group is buying white donor gametes to create Eurasian mixed children and thus ‘enhance’ their offspring. Providing novel empirical data, this article informs ethical deliberation and raises imminent questions for further research in this understudied geographic region and on cross-border reproductive treatment. (shrink)

This study examines recent French bioethics laws governing the uses of new reproductive and genetic technologies (NRGTs)—including in-vitro fertilization, surrogate motherhood, prenatal diagnostics, sex selection, and cloning—in light of feminist claims to women's rights, especially a woman's right to reproductive freedom. To this end, the study explores two interrelated questions: First, to what extent have French feminists supported NRGT development and treatment? Second, to what extent do French national bioethics debates, laws, and policies reflect feminist reactions to (...) NRGTs? The investigation of these questions is informed by recent theories of state feminism that show how national policy debates are gendered by particular sets of feminist ideas, and how policy choices resulting from these debates turn some of these ideas into law (McBride Stetson and Mazur 1995). Some of the most pressing feminist concerns in this area include women's loss of control over their bodies and fertility, women's exploitation and commercialization of their bodies, and women's health risks from NRGTs. The analysis of pronouncements by French feminist writers, researchers, and policy-makers reveals a multiplicity of feminist stances on NRGTs, showing keenly how feminists contest what constitutes effective feminist public policies to illuminate the fact that these policies are subject to shifting political contestations, rather than the reflection of a fixed set of feminist ideas. While contemporary French feminists grapple with the potential merits and dangers of NRGTS, the study shows that feminists generally seem to support NRGTs, as long as French law protects women's reproductive autonomy. Seen in this light, France's strong sense of the right to procreate through facilitation of access to NRGTs is not a contradiction of France's strong social and legal support for women's reproductive freedom, but rather enables French lawmakers to regulate NRGTs more effectively. (shrink)

This study examines recent French bioethics laws governing the uses of new reproductive and genetic technologies —including in-vitro fertilization, surrogate motherhood, prenatal diagnostics, sex selection, and cloning—in light of feminist claims to women’s rights, especially a woman’s right to reproductive freedom. To this end, the study explores two interrelated questions: First, to what extent have French feminists supported NRGT development and treatment? Second, to what extent do French national bioethics debates, laws, and policies reflect feminist reactions to (...) NRGTs? The investigation of these questions is informed by recent theories of state feminism that show how national policy debates are gendered by particular sets of feminist ideas, and how policy choices resulting from these debates turn some of these ideas into law. Some of the most pressing feminist concerns in this area include women’s loss of control over their bodies and fertility, women’s exploitation and commercialization of their bodies, and women’s health risks from NRGTs. The analysis of pronouncements by French feminist writers, researchers, and policy-makers reveals a multiplicity of feminist stances on NRGTs, showing keenly how feminists contest what constitutes effective feminist public policies to illuminate the fact that these policies are subject to shifting political contestations, rather than the reflection of a fixed set of feminist ideas. While contemporary French feminists grapple with the potential merits and dangers of NRGTS, the study shows that feminists generally seem to support NRGTs, as long as French law protects women’s reproductive autonomy. Seen in this light, France’s strong sense of the right to procreate through facilitation of access to NRGTs is not a contradiction of France’s strong social and legal support for women’s reproductive freedom, but rather enables French lawmakers to regulate NRGTs more effectively. (shrink)

Certain restrictions on public funding for assisted reproductive technology (ART) are articulated and defended by recourse to a distinction between medical infertility and social infertility. We propose that underlying the prioritization of medical infertility is a vision of medicine whose proper role is to restore but not to improve upon nature. We go on to mark moral responses that speak of investments many continue to make in nature as properly an object of reverence and gratitude and therein (sometimes) a (...) source of moral guidance. We draw on the work of Ludwig Wittgenstein in arguing for the plausibility of an appeal to nature in opposition to the charge that it must contain a logical fallacy. We also invite consideration of the moral plausibility of some appeal to nature. Finally, we examine what follows in the case of ART. Should medicine respect as natural limits that should not be overcome: the need for a man and a woman in reproduction; menopause; and even declining fertility with age? We must first ask ourselves to what degree we should defer to nature in the conduct of medicine, at least in the particular if not the general case. This will involve also asking ourselves what we think is natural and in what instances and spirit might we defy nature. Divergent opinions and policies concerning who should receive ART treatment and public funding are more easily understood in view of the centrality, complexity and fundamental nature of these questions. (shrink)

Background: Despite procedural innovations and increasing numbers of uterus transplant attempts worldwide, the perspectives of uterus transplant (UTx) trial participants are lacking. Methods: We conducted a mixed-methods study with women with absolute uterine factor infertility (AUFI). Participants included women who had previously contacted the Cleveland Clinic regarding the Uterine Transplant Trial and met the initial eligibility criteria for participation. In-depth interviews were conducted in conjunction with FertiQoL, a validated and widely used tool to measure the impact of infertility on the (...) quality of life of infertility patients. Results: All (n = 19) rated their overall health as good; some experienced grief and social isolation. AUFI is a life-framing experience that influences acceptance by family, partners, peers, and one’s self. UTx is a means to gain control of reproductive autonomy. UTx allows family-building and the ability to play an active role in prenatal health and well-being. Establishing and maintaining a supportive relationship is a key issue of AUFI and when considering UTx. Risks of UTx are perceived relative to risks to self/child/family posed by adoption/surrogacy. Participants had no overall preference regarding living or deceased donor. Conclusions: The ways in which women with AUFI conceptualize this condition in their lives and choices around UTx and participating in a study of the procedure are multifaceted and textured. These perspectives are critical to understanding its ethical, legal, and social implications. (shrink)

Current law in Victoria, Australia requires that all prospective assisted reproduction patients provide a criminal background check and child protection order check prior to being eligible for treatment. These presumptions against treatment stipulated in the Assisted Reproductive Treatment Act are discriminatory against all people that are infertile. Requiring assistance in founding a family says nothing about whether someone will be a minimally decent parent to their child. The most plausible justifications for this differential treatment of (...) family builders that require assistance are unsound. The wellbeing of the resulting child is something that the prospective patient should be presumed to have at heart, as this is the default assumption with other kinds of family builders that do not require assistance. That assisted reproduction treatment is publicly funded does not mean that the state is thereby justified in putting moral conditions on access to treatment. As we should not accept discriminatory laws, especially about practices that are of fundamental importance to the lives of citizens, the presumptions against treatment stipulated in ARTA should be eradicated. (shrink)

In Evans, both the U.K. High Court and Court of Appeal upheld Howard Johnston’s right to refuse Natallie Evans access to the stored embryos which represented her only hope of having a child which was genetically her own. In this note, I focus on claims of gender (in)equality in the resolution of Evans. My argument is that such claims are often made all too easily, without full consideration of the problems of advancing them in the context of procreative decision-making, where (...) men and women are inevitably differently situated. I conclude that although equality arguments are not wholly without value in this context, they need be used with extreme care. And, with due caution, I set out an equality argument of my own which was not made in Evans. (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)

Definition of the problemIn medicine and bioethics, the term “suffering” is not clearly defined from a normative point of view. Nevertheless, suffering due to infertility is the starting point for medical interventions in assisted reproductive medicine. This implies that the unfulfilled desire to have children is a form of suffering, but the validity of this statement has not yet been clarified.ArgumentsBased on descriptions of some common concepts, certain characteristics of suffering are identified. We discuss the significance of suffering as (...) an anthropological condition in connection with the mission of medicine to alleviate human suffering. Furthermore, the risks of reproductive treatment and their significance for health are addressed.ConclusionWe conclude that the unfulfilled desire to have children is a form of suffering, and therefore has a normative value. The legitimacy of appropriate somatic intervention can only be established by taking the psycho-existential dimension of suffering into account. (shrink)

Respect for autonomy is a central value in reproductive ethics, but it can be a challenge to fulfill and is sometimes an outright puzzle to understand. If a woman requests the transfer of two, three, or four embryos during fertility treatment, is that request truly autonomous, and do clinicians disrespect her if they question that decision or refuse to carry it out? Add a commitment to justice to the mix, and the challenge can become more complex still. Is (...) it unfair for insurance policies to exclude from coverage the costs of giving fertility to those who lack it or restoring fertility in those who have lost it? What does “just reproduction” look like in the face of multifarious understandings of both justice and autonomy and in light of increasingly complex and costly reproductive technologies? In today's dialogue about reproduction, medicine, and ethics in the United States, old ethical issues—such as whether women ought to be allowed to access pregnancy termination—are more contested than they have been in decades, while new technologies—like those used to edit the genes of human embryos—suggest that our species could face unprecedented questions about who should exist. As we considered the discussions accompanying these issues and contemplated a special report responding to them, we found ourselves consistently circling back to two ethical commitments: respect for autonomy and the pursuit of justice. As one of the nine essays in this collection asks, why should certain women receive help to establish a pregnancy while others are thrown in jail when they miscarry or their child is stillborn? Respect for autonomy is required where individuals have the ability to make fully informed and voluntary choices. Yet does respecting autonomy require acceding to all the choices of patients or consumers of medical care? We consider these and related questions in this special report from the Hastings Center Report. (shrink)

Catholicism is the most restrictive world religion in its position on assisted reproductive technologies. The opposition of the Church, combined with the widespread acceptability of ARTs in the United States, creates a profound moral dilemma for those who adhere to Church doctrine. Drawing on interviews from 33 Catholic women, this study shows that devout women have different understandings of these technologies than women from treatment-based studies. These differences are rooted in devout women’s position of navigating two contradictory cultural (...) schemas—“religious” and “secular”—regarding the meaning of reproductive technologies. Religious schemas provide devout women with different cultural resources that help them to avoid using ARTs while still reckoning with the ideal of biological parenthood. I show how devout women draw on religion to find value and meaning in their suffering, move beyond biological motherhood, and achieve a moral femininity. While religion increases the burden of reproduction for devout women, it also provides the cultural resources to resist the financial, emotional, and physical difficulties experienced by women who use ARTs. (shrink)

One of the areas of concern raised by cross-border reproductive travel regards the treatment of women who are solicited to provide their ova or surrogacy services to foreign consumers. This is particularly troublesome in the context of developing countries where endemic poverty and low standards for both medical care and informed consent may place these women at risk of exploitation and harm. We explore two contrasting proposals for policy development regarding the industry, both of which seek to promote (...) ethical outcomes and social justice: While one proposal advocates efforts to minimize cross-border demand for female reproductive resources through the pursuit of national self-sufficiency, the other defends cross-border trade as a means for meeting the needs of vulnerable groups. Despite the conflicting objectives of the proposed strategies, the paper identifies common values and points of agreement between the two, including the importance of regulations to safeguard those providing ova or surrogacy services. (shrink)