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What price parenthood?

Current reproductive technology challenges us to think seriously about social values surrounding childbeating. Thoughtful discussion must combine careful attention to the experience of pursuing parenthood by technological means with principled reflection on the morality of this pursuit

The ceremony goes as usual.

I lie on my back, fully clothed except for the healthy white cotton underdrawers. What I could see, if I were to open my eyes, would be the large white canopy of Serena Joy's outsized colonial-style four-poster bed, suspended like a sagging cloud above us...

Above me, towards the head of the bed, Serena Joy is arranged, outspread. Her legs are apart, I lie between them, my head on her stomach, her pubic bone on the base of my skull, her thighs on either side of me. She too is fully clothed.

My arms are raised; she holds my hands, each of mine in each of hers. This is supposed to signify that we are one flesh, one being. What it really means is that she is in control, of the process and thus of the product...

My red skirt is hitched up to my waist, though no higher. Below it the Commander is fucking. What he is fucking is the lower pan of my body. I do not say making love, because this is not what he's doing. Copulating too would be inaccurate, because it would imply two people and only one is involved. (Margaret Atwood, The Handmaid's Tale).

This chilling depiction of the process of reproduction in the fictional Republic of Gilead provides a vision of what many feminists believe will soon be reality if the new reproductive technologies (NRTS) proceed unchecked. Children will be thought of exclusively as products. Women will be valuable merely as breeders. Reproductive prostitution Y611 emerge as women are forced to sell wombs, ovaries, and eggs in reproductive brothels.' Men will be more fully in control than ever.

There was a time when I would have dismissed such claims as wildly alarmist. I still believe these worries to be overblown. Yet I have been haunted by this passage from The Handmaid's Tale as I have stood, month after month, holding my wife Lisa's hand as she, feet in stirrups, has received my sperm from the catheter that her doctor has maneuvered into her uterus. Indeed, once, when the nurse asked me to stand behind her to hold steady an uncooperative light I wondered perversely whether I shouldn't, like Serena joy, play my symbolic pall by moving rhythmically as the nurse emptied the syringe. Having experienced the world of reproductive medicine firsthand, I believe we need to take a closer look at feminist objections to NRTS.

Here, then, I will review objections that some feminists have raised to such technologies as in vitro fertilization (FVF), artificial insemination with donor sperm (AID), and surrogate motherhood, and relate these objections to my own experience. I take up feminist objections because, although there is no one "feminist" response to reproductive technology, some of the most forceful objections to this technology have come from writers who are self consciously feminist and understand their opposition to the NRTS to be rooted in their feminism. Moreover, the international feminist organization FINRRAGE (Feminist International Network of Resistance to Reproductive and Genetic Engineering) is committed to opposing the spread of reproductive technology, and it is from this group that we have the most sustained and systematic attack on NRTS in the literature. I relate these objections to my own experience because, in my view, all serious moral reflection must attend to the concrete experience of particular individuals and thus inevitably involves a dialectical movement between general principles and our reactions to particular cases. The need to balance appeals to abstract rules and principles with attention to the affective responses of particular individuals has not always been sufficiently appreciated in moral theory or in medical ethics.' Yet such a balance is necessary if we are to understand both how moral decisions are actually made and how to act compassionately when faced with troubling moral situations.

My experience leads me to believe that there are some real dangers in pursuing these technologies, that individuals should resort to them only after much soul searching, and that society should resist efforts to expand their use in ways that would make them available as something other than a reproductive process of last resort. In the case of my wife and me, this soul searching is upon us. It now appears that artificial insemination with my sperm will not be successful. We are thus confronted with the decision of whether to pursue in vitro fertilization, artificial insemination with donor sperm, or adoption. This paper is one moment in that process of soul searching.

Like many couples of our generation and background, my wife and I delayed having children until we completed advanced degrees and began our jobs. With careful deliberation, we planned the best time to have children given our two careers, and were diligent in avoiding pregnancy until that time. What we had not planned on was the possibility that pregnancy would not follow quickly once we stopped using birth control. This had not been the experience of our friends whose equally carefully laid plans had all been realized. For them, birth control ended and pregnancy followed shortly thereafter. For us, a year of careful effort, including charting temperatures and cycles, yielded only frustration.

Because we had indeed been careful and deliberate in trying to conceive, we suspected early on that there might be a problem and we thus sought professional help. A post-coital examination by my wife's gynecologist revealed few, and rather immobile sperm. I was referred to a specialist for examination and diagnosed as having two unrelated problems: a varicocele and retrograde ejaculation. A varicocele is a varicose vein in the testicle that is sometimes associated with a reduction in both the numbers and quality of sperm. Retrograde ejaculation is a condition in which a muscle at the neck of the bladder does not contract sufficiently during ejaculation to prevent semen from entering the bladder. As a result, during intercourse semen is ejaculated into the bladder rather than into the vagina. Both conditions are treatable, in many cases. Indeed, the doctor's diagnosis was followed almost immediately by a presentation of possible "therapies," given roughly in the order of the doctor's preferences, all presented as points on the same therapeutic continuum. A varicocele can be repaired surgically. Retrograde ejaculation can sometimes be eliminated through the use of drugs and, failing that, can be circumvented by recovering sperm from urine and using it for artificial insemination. Should both these treatments fail, in vitro fertilization might be successful. And, if all else fails, donor insemination is always a possibility.

Since surgery for a valicocele is not always successful and since surgery is more invasive than either of the treatments for retrograde ejaculation, I tried these latter treatments first. Unfortunately, neither drug therapy nor artificial insemination was of any avail. Possibly because of damage done to the sperm as the result of the varicocele, the numbers and quality of sperm recovered from urine for insemination were not such as to make conception likely. After trying artificial insemination (AIH) for six months, we decided to attempt to repair the varicocele. Following this surgery, there is generally a three to nine month period in which a patient can expect to see improvement in his sperm count. After nearly seven months, we have seen virtually no improvement. Although we have begun AIH once again, we do not have high hopes for success.

This is the bare chronicle of my infertility experience. A complete record would be too personal, too painful, and too long to present here. But something more should be said. For someone who loves children, who has always planned to have children, infertility is an agonizing experience. In a culture that defines virility so completely in phallocentric terms, infertility can also threaten male identity, for infertility is often confused with impotence. Infertility is damaging in other ways as well. The loss of intimacy as one's sex life is taken over by infertility specialists strains a relationship. More generally, the cycle of hope and then despair that repeats itself month after month in unsuccessful infertility treatment can become unbearable. Nor is the experience of infertility made easier by the unintended thoughtlessness or uncomfortable attempts at humor of others. It is hard to know which is worse: to endure a toast on Father's Day made with great fanfare by someone who knows full well your efforts to become a father or to suffer yet another comment about shooting blanks."

With this as background, I would like to consider four interrelated, but distinct objections that have been raised to NRTS. According to feminist opponents, the new reproductive technologies are inescapably coercive; lead to the dismemberment of motherhood; treat women and children as products; and open the door to widespread genetic engineering.

The Tyranny of Technology

Although opponents of reproductive technology do not generally distinguish types of coercion, there are typically two sorts of claims made about NRTS. The first is that the very existence (and availability) of these technologies constitutes a sort of coercive offer; the second, that the future of these technologies is likely to include coercive threats to women's reproductive choices. The first claim is often a response to the standard reasons given for developing these technologies. Advocates of NRTS typically argue that these techniques are developed exclusively to help infertile couples, expanding the range of choices open to them.' Moreover, the medical community is portrayed as responding to the needs and interest of infertile patients to find technological means to produce pregnancy if the natural ones fail. IVF programs, for example, are almost always defended on the grounds that however experimental, painful, or dangerous they may be to women, women choose to participate in them. Thus, it is said, IVF increases choice.

Feminists who believe NRTS to be coercive claim that such a choice is illusory, because in a culture that so thoroughly defines a woman's identity in terms of motherhood, the fact that women agree to participate in IVF programs does not mean they are truly free not to participate. According to this view, we must not focus too quickly on the private decisions of individuals .8 Individual choices are almost always embedded in social contexts, and the context in our culture is such that a childless woman is an unenviable social anomaly. To choose to be childless is still socially disapproved and to be childless in fact is to be stigmatized as selfish and uncaring. In such a situation, to offer the hope of becoming a mother to a childless woman is a coercive offer. Such a woman may well not wish to undergo the trauma of an in vitro procedure, but unwillingly do so.

Robyn Rowland has appreciated the significance of this social context for infertile women. "In an ideological context where child beating is claimed to be necessary for women to fulfill themselves," she writes, "whether this is reinforced by patriarchal structures or by feminist values, discovering that you are infertile is a devastating experience."' The response may be a desperate search to find any means of overcoming this infertility, a search that may render the idea of choice in this context largely meaningless.

Moreover, feminists insist, developing these technologies is not about increasing choice. They are not, by and large, available to single womeninfertile or not-or to lesbian women. Further, if doctors were truly concerned for the suffering of infertile women, we would expect much greater effort to publicize and to prevent various causes of infertility, including physician-induced sterility, as well as to inform women more fully about the physical and emotional trauma that various types of fertility treatments involve. This neglect became dramatically apparent to me when I discovered Lisa at home weeping quietly but uncontrollably after a "routine" salpingogram for which she was utterly unprepared by her doctor's description of the procedure." I will return to this theme below but I hope the claim of feminist opponents of the NRTS is clear. If doctors were in fact concerned about the well-being of their infertile patients, they would treat them less as objects to be manipulated by technologies and more as persons. The fact that this is often not the case should reveal something about the underlying motivations.

The second claim about the possibility of coercive threats is really a concern about the future. While we may debate whether a desperately infertile woman really is free to choose not to try in vitro fertilization, still, no one is forcing her to participate in an IVF program. But what about the future? This question is meant to point to how thoroughly medicine has encroached on the birth process. The use of ultrasound, amniocentesis, genetic testing and counseling, electronic fetal monitoring, and cesarean sections have all increased the medical community's control over the process of birth. Why should the process of conception be any different? If anything, a pattern suggests itself What was originally introduced as a specialized treatment for a subclass of women quickly expanded to cover a far wider range of cases. What was originally an optional technology may quickly become the norm.

Such interventions can be coercive not only in the sense that, once established as the norm they are difficult to avoid, but in the stricter sense that women may literally be forced to submit to them, as with court-ordered cesarean sections. Will compulsory treatment be true of the new technologies as well? Will the technology that allows for embryo flushing and transfer in surrogate cases be required in the future as part of a process of medical evaluation of the fetus? The concern that the answers to these questions is too likely to be "yes" stands behind some claims that the NRTS are dangerously coercive. The potential for a loss of control over one s reproductive destiny is increased with the development of these technologies. And the coercion that could follow such a loss of control is worrisome.

Have I experienced a loss of control or coercion? The answer is a qualified yes. I certainly have not felt coerced in the second sense. I have not been physically forced to undergo infertility treatment nor has there been any threat, actual or implied, connected with the prospect of avoiding NRTS altogether. Still, I have experienced the existence of these technologies as coercive. And here the notion of a coercive offer is helpful. Although the inability to have children has not threatened my social identity in the same way it might were I a woman, nevertheless, the pressure is real. Having experienced this pressure, and having met others whose desperation to bear a child was almost palpable, I do not doubt that the offer of hope held out by available technologies, however slim and unrealistic in some cases, is indeed a form of coercion.

The problem here might reasonably be called the tyranny of available technologies. This soft" form of coercion arises from the very existence of technologies of control. Increased control by the medical profession over the birth process, for example, has not resulted because of a conspiracy to gain control, but rather because, once the technology of control exists, it is nearly impossible not to make use of it. If, as I believe, this pressure to make use of existing technologies is a type of coercion, I have experienced this coercion powerfully during my infertility treatment. If surgery might repair the problem, even if the chances are not great, how can I not have surgery? If surgery and artificial insemination have not worked, but some new technique might, how can I not try the new technique?

The very existence of the technology inevitably changes the experience of infertility in ways that are not salutary. One of the peculiar aspects of infertility is that it is a condition that a couple suffers. Individuals can have retrograde ejaculation or blocked tubes, but only couples can be infertile. As Leon Kass has noted, infertility is as much a relationship as a condition. Yet infertility treatment leads us to view infertility individually, with unfortunate consequences. The reason is that couples will often not be seen together in infertility treatment, and, even when they are, they will receive individual workups and be presented with individual treatment options. Now it might be said that providing individuals with options increases agency rather than diminishes it. Yet with this agency comes a responsibility that may not itself be chosen and that reduces the prospects for genuine choice. For once an individual is presented with a treatment option, not to pursue it is, in effect to choose childlessness and to accept responsibility for it. From a situation in which infertility is a relational problem for which no one is to blame, it becomes an individual problem for which a woman or man who refuses treatment is to blame." Reproductive technology structures the alternatives such that a patient is "free" to pursue every available form of assisted reproduction or to choose to be childless.

This problem is compounded by the fact that infertility specialists simply assume that patients vill pursue all available treatments and typically present the variety of treatment options as just different points on the same therapeutic spectrum, distinguished primarily by degree of invasiveness. In our case, taking relatively mild drugs in an effort to make an incontinent muscle more efficient lies at one end of the continuum, at the other end of which lies IVF. Surgery, I suppose, falls somewhere in the middle. At no time in my experience, however, has anyone suggested that treatments differ qualitatively. (The only exception to this was my urologist's opposition to an experimental treatment for malefactor infertility.) It has generally been assumed that if one therapy fails, we will simply move on to the next. And that is the problem. If the technology exists, the expectation is that it mill be used. Again, if IVF might work, how can we not try it? The force of these questions covers us like a weight as we consider what to do next.

The Dismemberment of Motherhood

A second objection raised against the NRTS is that they question the very meaning of motherhood. The reality of oocyte donation, embryo flushing, and embryo transfer produces another possible reality: the creation of a child for whom there are three mothers: the genetic mother, the gestational mother, and the social mother. 16 In such a situation, who is the real mother? In the absence of a compelling answer, the claim of each of these three women to the child will be tenuous. Maternity will be as much in dispute as paternity ever was. And whatever criteria are used to settle this issue, the result for women is that the reproductive experience may become discontinuous in much the way it has traditionally been for men. Just as paternity has been uncertain because the natural, biological relation between the father and child could always be questioned, so too might maternity become a sort of abstract idea rather than a concrete reality. just as paternity has been a fight rather than a natural relation, so too might maternity become."

The significance of this can be seen if one takes seriously Mary O'Brien's claims that men's reproductive experience of discontinuity, that is, the inevitable uncertainty of genetic continuity, has contributed significantly to men's need to dominate. The problematic nature of paternity, O'Brien suggests, can account for the sense of isolation and separation so common in men, in part because for men the nature of paternity is such that the natural experimental relation of intimacy with another is missing.

Feminists' celebrations of motherhood have also made much of the biological continuity women have traditionally experienced with their children. Caroline Whitbeck and Nancy Hartsock, for example, have both discussed how the biological differences between men and women, especially as they are manifested in reproduction, account for some of the differences in how men and women experience the world."' Many women do not experience the sharp separation between self and others so common to male experience, Harlsock and Whitbeck note, a fact both explain by appeal to the way in which female physiology mediates female experience. In the case of women who are mothers, the experience of pregnancy, labor, childbirth, and nursing shape a way of responding to the world and to others. For a mother whose milk lets down at the sound of her child's cry, a sense of deep connection and continuity is established."'

On this view, the danger of the new technologies of birth is precisely that they alienate women from procreation and thus rob them of one of the most significant sources of power and identity. It is precisely this realization that leads Connie Ramos, a character in Marge Piercy's Woman on the Edge of Time, to react with such horror at the division of motherhood envisioned by Piercy. In a world where gestation takes place in artificial wombs, where men as well as women nurse the young, women have lost something of tremendous value and men have gained something they always wanted: control of reproduction. Connie's response to seeing a breast feeding male poignantly expresses this point:

She felt angry. Yes, how dare any man share that pleasure. These women thought they had won, but they had abandoned to men the last refuge of women. What was special about being a woman here? They had given it all up, they had let men steal from them the last remnants of ancient power, those sealed in blood and in milk. 20

One of the gravest concerns raised about the new technologies of birth, then, is that they represent the culmination of a patriarchal imperative: to gain for men what they have always lacked, namely, the power to reproduce. The fear is that this desire is close to realization. Gena Corea has put this point forcefully:

Now men are far beyond the stage at which they expressed their envy of woman's procreative power through couvade, transvestism, or subincision. They are beyond merely giving spiritual birth in their baptismal-font wombs, beyond giving physical birth with their electronic fetal monitors, their forceps, their knives. Now they have laboratories.

Since this objection essentially focuses on the impact on women of the NRTS, my experience cannot speak directly to this issue. Nevertheless, because part of what is at stake is the importance of the unity of genetic and social parenthood, as well as the unity of genetic and gestational parenthood, this is not a concern exclusively of women; it is a concern I have confronted in reflecting about donor insemination and adoption. One of the most striking aspects of my experience is how powerfully I have felt the pull of biological connection. Does this mean that genetic and social parenthood should never be separated or that parenthood should be defined strictly as a biological relation? I believe the answer to both questions is "no," but my experience leads me to believe also that a unity of genetic, gestational, and social parenthood is an ideal that we ought to strive to maintain.

The Commodification of Reproduction

The third objection found in some of the feminist literature on NRTS is that they tend to treat human beings as products. Not only can these technologies divide up motherhood, they can divide up persons into parts. Even when they are used to treat infertility, it is often not men or women who are being treated, but testicles, sperm, ovaries, eggs, wombs, etc. While this is true to some extent of all treatment in the specialized world of modern medicine, it is acute in reproductive medicine. Robyn Rowland has described the situation as one in which women especially are treated as "living laboratories" in which body pans and systems are manipulated in dramatic fashion without knowledge about the consequences of such manipulation. Clearly, this has been the case in the development of in vitro fertilization, where women have not been adequately informed about the experimental nature of the procedure, possible side effects, or poor success rates.

In addition, the language of reproductive medicine can also be dehumanizing. Eggs are "harvested" as one might bring in a crop. Body parts are personified and thus attributed a sort of individuality and intentionality; cervical mucus is said to be hostile," the cervix itself is said to be incompetent," and the list could go on.

Yet as troubling as the language and practice surrounding this technology may be in treating persons like products, it is the application of this technology that treats persons as products that is completely objectionable. This has clearly happened with the development of a commercial surrogate industry and donor sperm banks, and it is the danger that attends the establishment of oocyte donor programs. Indeed, Corea's idea of a reproductive brothel seems inescapable. If there are not yet houses of ill repute where one can go to purchase embryos and women to gestate them, there are brochures available containing pictures and biographical information of women willing to sell their services. Nor can the development of commercial surrogacy arrangements be dismissed as the misguided and unintended application of reproductive techniques, an application of NRTS mistakenly and uncharacteristically driven by the profit motive. Treatment of infertility is big business, and the drive to develop reproductive technology is clearly fueled by financial incentives."

Nothing perhaps illustrates this more clearly than the development of an embryo flushing technique by a team of physicians at Harbor-UCLA Medical Center. In April 1983, this team successfully flushed an embryo from one woman and transferred it to a second woman who carried the fetus to term. The project was funded by Fertility and Genetics Research, a for-profit company begun by two physicians who envisioned the establishment of a chain of embryo transfer clinics where infertile women could purchase embryos to gestate themselves. Indeed, to insure maximum profits for themselves, the Harbor-UCLA team sought to patent the equipment and the technique they developed.24

Not only do men and women get treated as products, so do children. The logic here is clear enough. If women are paying for embryos or being paid for eggs, the embryos and the eggs cannot but be understood as products. Because they are products, buyers will place demands on them. We will expect our products to meet certain standards and, if they fail, we will want to be compensated or to return the damaged goods. In a society that sells embryos and eggs for profit, children will inevitably be treated as property to be bought and sold, and just as inevitably it follows that different children will carry different price tags. As Barbara Katz Rothman puts it, "some will be rejects, not salable at any price: too damaged, or the wrong colour, or too old, too long on the shelf."

My own experience leads me to believe that this tendency toward the commodification of reproduction is one of the most worrisome aspects of the NRTS. In pan, this tendency is troubling because it manifests itself not simply in commercial surrogacy transactions-transactions that many if not most people find morally problematic-but in applications of these technologies that almost no one questions. For example, few, I believe, would have qualms about the sort of artificial insemination that Lisa and I have undertaken and yet perhaps the most difficult part of AIH for us has been the struggle to maintain a degree of intimacy in the process of reproduction in the midst of a clinical environment designed to achieve results. As Katz Rothman has pointed out, the ideology of technology that fuels this commodification is not reducible to particular technological tools or to particular commercial transactions. Rather it is a way of thinking of ourselves and our world in "mechanical, industrial terms," terms that are incompatible with intimacy. Interestingly, the Roman Catholic Church has rejected AIH precisely because it separates procreation from sexual intercourse and the expression of love manifest in the conjugal act. While I reject the act-oriented natural law reasoning that stands behind this position, there is an insight here that should not be overlooked. Once procreation is separated from sexual intercourse, it is difficult not to treat the process of procreation as the production of an object to which one has a fight as the producer. It is also difficult under these circumstances not to place the end above the means; effectiveness in accomplishing one's goal can easily become the sole criterion by which decisions are made.

This anyway, has been my experience. Although Lisa and I tried for a time to maintain a degree of intimacy during the process of AIH by remaining together during all phases of the procedure as well as after the insemination, we quickly abandoned this as a charade. The system neither encourages nor facilitates intimacy. It is concerned, as it probably should be, with results. And so we have become pragmatists too. We do not much en enjoy the process of AIH, to say the least, but we also do not try to make it something it is not. A conception, if it takes place, will not be the result of an act of bodily lovemaking, but a result of technology. We have come to accept this. Yet, such acceptance comes at a price, for our experience of reproduction is discontinuous. A child conceived by this method is lovingly willed into existence, but it is not conceived through a loving, bodily act.

Having accepted the separation of sexual intercourse and procreation, however, it is difficult to resist any sort of technological manipulation of gametes that might result in conception. We have, so to speak, relinquished our gametes to the doctors and once this has been done, how can various technological manipulations be judged other than by criteria of likelihood of success; This is precisely the problem: once one has begun a process that inevitably treats procreation as the production of a product, the methods of production can only be evaluated by the end result.

Reproductive Technologies and Genetic Engineering

The fourth objection to NRTS is that their general acceptance and use is an inevitable route to widespread use of genetic engineering. It should be no mystery why this might be thought to be the case. Once the embryo, for example, is treated as a product to be bought and sold, there will be great pressure to produce the perfect product. The attraction of genetic engineering under such circumstances should be obvious. Genetic screening and therapy would be a sort of quality control mechanism by which to insure customer satisfaction. Moreover, the greater access to embryos and to eggs provided by IVF and embryo flushing means that genetic manipulation of the eggs or the developing embryo is now more feasible than it once was. Even more importantly, however, this greater access to embryos and eggs, combined with the possibility of freezing and storing those not used to attempt a pregnancy, means that experimentation can go forward at a much faster rate. Scientists have experimented with the injection of genetic material into non-human eggs for some time, and a recent issue of Cell reported the introduction of foreign genetic material into mouse sperm. It is not unreasonable to suppose that such manipulations will one day extend to human gametes. Indeed, one experimental technique being developed to treat forms of male infertility in which sperm is unable to penetrate the egg involves isolating a single sperm in order to introduce the sperm directly into the egg. The obvious question is: How will this sperm be selected? The most likely answer will be: by a determination that it is not genetically abnormal.

Thus far, most genetic experimentation, manipulation, and screening has been defended by appeal to the goal of eliminating human suffering. If genetic abnormalities can be detected or even treated, much human suffering might either be avoided or alleviated. Yet, how does one distinguish between attempts to eliminate suffering and attempts at eugenics? The fact that it is so difficult to answer this question is one reason to be concerned about NRTS. Moreover, the equation of genetic abnormality or disability with suffering can be questioned. As Marsha Saxton has pointed out, we cannot simply assume that disabled people "suffer" from their physical conditions any more than any other group or category of individuals "suffer." Indeed, decisions about bearing genetically damaged fetuses are generally made in relative ignorance of what sorts of lives potential offspring might actually have. "Our exposure to disabled children," Saxton writes, "has been so limited by their isolation that most people have only stereotyped views which include telethons, [and] displays on drugstore counters depicting attractive crippled' youngsters soliciting our pity and loose change" (306).

If reproductive technology is developed because every person has a fight to bear a child, does it not follow that every person has a right to bear a perfect child? Advocates of NRTS would not admit this, and yet it seems to be the logical conclusion of the commitment to produce a child, no matter the cost. To see the difficulties here, we need only ask how we are to define the perfect child, and whether a commitment to eliminate genetic abnormalities means that women will lose the freedom not to test for or to treat abnormalities.

In my view, the concern here is a real one for, once one has begun to think in terms of producing a product, it becomes exceedingly difficult to distinguish between technological interventions except on the basis of the resulting product. And since the product one desires in this instance is a healthy baby, a technological intervention that helps to achieve this, even one that involves genetic manipulation, is likely to be both initially attractive and ultimately irresistible. My own reaction to the new technique of overcoming male infertility by isolating a single sperm and injecting it into an egg it would otherwise be unable to penetrate is instructive. My initial response was that of tremendous excitement. Here was a treatment that could clearly overcome our problem. The fact that I did not produce great numbers of sperm or that the ones I produced were not likely to be capable of penetrating an egg did not matter. In theory, very few sperm are required and the work of penetration is done for them. The fact that such a technique involves placing an extraordinary amount of control in the hands of the doctor who selects the single sperm from among the many millions that even a man with a low sperm count is likely to produce did not even occur to me. In fact, it was my doctor, who had moral reservations about this technique, who first pointed this out to me. What is perhaps more troubling, however, is that when the issue of control was pointed out to me, I found no immediately compelling reason to object. I had, after all, been routinely providing sperm for a lab to manipulate in an effort to produce a collection that was capable of penetrating my wife's egg. Was selecting a single sperm that could accomplish the goal really so different?

In light of these various objections and my own experience, then, my basic response is one of concern. I do not believe that the predominantly male medical profession is acting in bad faith in developing reproductive technologies, as some critics suggest. Much of the feminist literature on NRTS is cynical and deeply contemptuous of what is seen as a patriarchal and conspiratorial medical establishment. My own experience, however, does not bear this out. Although there is much about my treatment for infertility that I have found frustrating, anxiety-producing, and distasteful, and although I have felt at turns coerced by the existence of the technologies themselves; angry at the loss of intimacy in my relationship with Lisa; and worried by my own near obsession with the goal of achieving a pregnancy, I have never had reason to doubt the sincerity of my doctor's care and concern. That my experience has been so negative despite treating with a doctor who is very much aware of the potentially dehumanizing aspects of infertility treatment is further evidence of how serious the problems with these technologies may be.

This is not to deny that infertility specialists are too concerned with technological fixes; in my view, they are. While there is no conspiracy to gain control of the process of reproduction, there is increased control. And if one theme joins the various objections to the new reproductive technologies, it is that they increase the medical profession's control over the process of reproduction and that such control has deleterious consequences. We have not, by and large, thought through the consequences of this son of intervention and control. Neither infertile couples nor those who try to alleviate their suffering, nor indeed the community that is generally supportive of the desire to have children has really asked whether that desire should be met at all costs. Is the desire to have children a desire for a basic human good? Can it be met through adoption or only through biological offspring? Are there other, competing social goods that set limits on how far we, as a community, should go to meet this need? These are certainly questions that I had not addressed before my experience of infertility. Even now I am not certain how to answer all of them. I am certain, however, that my desire to have children is strong. I am also equally certain that we need to attend to these questions as a society. For anyone not blinded by self deception will admit that wanting something does not always make it light Acknowledgments A number of individuals both encouraged me to go forward with this essay, and provided me with very helpful suggestions for revisions. Thanks to Lisa Cahill, Lisa de Filippis, Howard Eilberg-Schwartz, Tom Kelly, Gilbert Meilaender, Louis Newman, John P. Reeder, Jr., David H. Smith, Claudia Spencer, John Spencer, and Brian Stiltner. I also received very helpful comments from the works-in-progress group at the Center for Bioethics at the Case Western Reserve University School of Medicine and the participants in a NEH sponsored Humanities and Medicine Institute at Hiram College held in collaboration with the Northeastern Ohio Universities College of Medicine.


1. See Gena Corea, "The Reproductive Brothel" in Man-made Woman, Gena Corea et al., eds. Bloomington: Indiana University Press, 1987), 38-51.

2. The medical profession has gone to some lengths to insure that artificial insemination is defined as a medical procedure, and thus controlled by doctors. Most of my wife's inseminations have been administered by doctors, even when this has been inconvenient for us. The two exceptions have been when Lisa ovulated on the weekend and then, apparently, insemination did not need to be performed by a doctor.

3. Although for convenience I will refer in this paper to "feminist" objections, I cannot stress enough that there is not one feminist response to reproductive technology, but several. Indeed, feminist responses range from enthusiastic support to moderate and cautious support to radical opposition. See Anne Donchin, "The Future of Mothering: Reproductive Technology and Feminist Theory," Hypatia (1986), 121-37.

4. Patricia Spallone and Deborah Lynn Steinberg, eds., Made to Order (Oxford: Pergamon Press, 1987).

5. But see Sidney Callahan, "The Role of Emotion in Ethical Decisionmaking," Hastings Center Report 18:3 (1988), 9-14.

6. On the difference between coercive offers and coercive threats, see Virginia Held, "Coercion and Coercive Offers," in Coercion, J. Roland Pennock and John Chapman, eds. (Chicago: Atherton, 1972), 49-62.

7. I use "couples" here intentionally. The justification for developing reproductive methods is almost always to help infertility within marriage. There is an irony in this: Although physicians tend to treat infertility as a problem for an individual, they insist that that individual be part of a heterosexual marriage. Thus it is not just infertility that is of concern, but infertility in certain types of situations.

8. For a discussion of the difficulty of providing an adequate account of free choice given the assumptions of modem liberalism, see Barbara Katz Rothman, Recreating Motherhood (New York: WW Norton, 1989), 62.

9. Robyn Rowland, "Of Woman Born, But for How Long?" in Made to Order, 70.

10. See Spallone and Steinberg, eds., Made to Order, 6-7.

11. The test involves injecting radiopaque dye into the uterine cavity after which x-rays are taken. The fallopian tubes are outlined wherever the dye has penetrated. Using this procedure, it is sometimes possible to determine whether a woman's tubes are blocked.

12. Here my experience and Lisa's differ dramatically. The infertility specialist I have seen could not be more sensitive or attentive to the human dimension of our difficulties. By contrast, Lisa's experience with the gynecologists involved with insemination has been almost entirely negative, in part because she has not been treated fully as a person by them.

13. Spallone and Steinberg, eds., Made to Order, 4-5.

14. Leon Kass, Toward a More Natural S&" (New York: The Free Press, 1985), 45.

15. I am, in effect, suggesting that more choice is not always better. This is not a popular view in our culture, but it can be persuasively defended. For such a defense, see Gerald Dworkin, "Is More Choice Better than Less?," Midwest Studies in Philosophy 7, Peter A- French, Theodore E. Uehling, Jr., and Howard K. Wettstein, eds. (Minneapolis: University of Minnesota Press, 1982), 47-61.

16. Gena Corea, The Mother Machine (New York: Harper and Row, 1985), 290.

17. Mary O'Brien, The Politics of Reproduction (Boston: Routledge and Kegan Paul, 1981), 55.

18. See Nancy Hansock, "The Feminist Standpoint: Developing the Ground for a Specifically Feminist Historical Materialism," in Discovering Reality, Sandra Harding and Merrill B. Hintikka, eds. (Dordrecht: D. Reidel, 1983), 283-310; and Caroline Whitbeck, "A Different Reality: Feminist Ontology," in Beyond Domination, Carol C. Gould, ed. (Totowa, NJ: Rowman and Allanheld, 1983), 64-88.

19. Emily Martin, The Woman in the Body (Boston: Beacon Press, 1987).

20. Marge Piercy, Woman on the Edge of Time (New York: Ballantine Books, 1976), 134.

21. Corea, The Mother Machine, 314.

22. Robyn Rowland, "Women as living Laboratories: The New Reproductive Technologies," in The Trapped Woman, Josefina Figueira-McDonough and Rosemary Sani, eds. Newbury Park, CA: Sage Publications, 1987), 81-112.

23. According to the Office of Technology Assessment, $164 million is paid to close to 11,000 physicians every year for artificial inseminations alone. Add to this the variety of other infertility services provided every year to childless couples and the total cost is at least $1 billion (U.S. Congress, Office of Technology Assessment, Artificial Insemination Practice in the U.S.: Summary of a 1987 Survey [Washington: Government Printing Office, 1988]).

24. Although there are currently no franchised clinics in the U.S., the ovum transfer procedure using uterine lavage is commonplace. See Leonard Fonnigli, Graziella Fonnigli, and Carlo Roccio, "Donation of Fertilized Uterine Ova to Infertile Women," Fertility and Sterility 47:1 1987), 162-65.

25. Barbara Katz Rothman, "The Products of Conception: The Social Context of Reproductive Choices," Journal of Medical Ethics 11 (1985), 191.

26 The tendency to treat children as commodities is not solely the product of developing NRTS, of course, but the culmination of a process begun with the old reproductive technology of contraception. Once the inexorable connection between sexual intercourse and procreation was broken, it became possible to choose when to have children. From that point on, it made sense to treat children in some ways as products, the purchase of which, so to speak, could be planned as one planned the purchase of other expensive items.

27. Katz Rothman, Recreating Motherhood, 49.

28. Sacred Congregation for the Doctrine of the Faith, Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation, in Origins 16 (March 1987), 697-711.

29. Katz Rothman, "The Products of Conception," 188.

30. For a discussion of the transgenic animals that result from the genetic manipulation of eggs, see VG. Pursel et aL "Genetic Engineering of Livestock," Science 244 (1989), 128188. Also see M. Lavitrano et aL, "Sperm Cells as Vectors for Introducting Foreign DNA into Eggs: Genetic Transformation of Mice," Cell 57:5 (1989), 717-24.

31. Actually, there are at least three different techniques being investigated. SeeJon W Gordon et aL, Ferdlization of Human Oocytes by Sperm from Infertile Males After Zona Pellucida Drilling," Fertility and Sterility 50:1 (1988), 68-73.

32. Marsha Saxton, "Born and Unborn: The Implications of Reproductive Technologies for People with Disabilities," in Test-tube Women, Rita Arditti, Renate Duelli Klein, and Shelley Minden, eds. (London: Pandora Press, 1984), 298-313.

33. Anne Finger, "Claiming All of Our Bodies: Reproductive Rights and Disabilities," in Test-tube Women, 281-97.

34. See Ruth Hubbard, "'Fetal Rights' and the New Eugenics," Science for the People March/April 1984), 7-9, 27-29.
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Title Annotation:social and ethical aspects of reproductive technology
Author:Lauritzen, Paul
Publication:The Hastings Center Report
Date:Mar 1, 1990
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