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Access to In Vitro Fertilization: Costs, Care and Consent

Published online by Cambridge University Press:  13 April 2010

Christine Overall
Christine Overall
Affiliation:
Queen's University
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Extract

What would be a genuinely caring approach to the provision of procedures of so-called artificial reproduction such as in vitro fertilization (IVF)? What are appropriate and justified social policies with respect to attempting to enable infertile persons to have offspring? These urgent questions have provoked significant disagreements among theologians, sociologists, healthcare providers, philosophers and even — or especially — among feminists. In the existing literature and in developing social policy, three different kinds of answers can be discerned. (1) Some have suggested that access to IVF should be provided as a matter of right. (2) Some existing social policies and practices imply that access to IVF is a privilege. (3) Some theorists have argued that, because of its alleged violation of family values and marital security, or because of its risks, costs, and low success rate, IVF should not be available at all. After evaluating each of these views, I shall offer a feminist alternative, describing what I think would constitute the caring provision of in vitro fertilization.

Type
Articles
Information
Dialogue: Canadian Philosophical Review / Revue canadienne de philosophie , Volume 30 , Issue 3: Applied Ethics , Summer 1991 , pp. 383 - 398
Copyright
Copyright © Canadian Philosophical Association 1991

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References

Notes

1 For example, see Raymond, Janice G., “Reproductive Technologies, Radical Feminism, and Socialist Liberalism,” Reproductive and Genetic Engineering: Journal of International Feminist Analysis, 2, 2 (1989): 141.Google Scholar

2 Overall, Christine, Ethics and Human Reproduction: A Feminist Analysis (Boston: Allen & Unwin, 1987), p. 166–96.Google Scholar

3 Morgentaler, Smoling and Scott v. A. G. Canada, Supreme Court of Canada, January 28, 1988. Judgment by Justice Wilson, p. 15.

4 Ethics Committee of the American Fertility Society, “The Constitutional Aspects of Procreative Liberty,” in Ethical Issues in the New Reproductive Technologies, edited by Hull, Richard T. (Belmont, CA: Wadsworth, 1990), p. 9.Google Scholar

5 Robertson, John A., “Procreative Liberty, Embryos, and Collaborative Reproduction: A Legal Perspective,” in Embryos, Ethics and Women's Rights: Exploring the New Reproductive Technologies, edited by Baruch, Elaine Hoffman, D'Adamo, Amadeo F. Jr. and Seager, Joni (New York: Haworth Press, 1988), p. 180.Google Scholar Cf. Andrews, Lori B., “Alternative Modes of Reproduction,” in Reproductive Laws for the 1990s, edited by Cohen, Sherrill and Taub, Nadine (Clifton, NJ: Humana Press, 1989), p. 364.Google Scholar Robertson's heterosexist bias is not much mitigated by his later concession that there is “a very strong argument for unmarried persons, either single or as couples, also having a positive right to reproduce” (Robertson, “Procreative Liberty,” p. 181).

6 Robertson, “Procreative Liberty,” p. 180, 186 and 190.

7 Andrews, Lori B., New Conceptions: A Consumer's Guide to the Newest Infertility Treatments (New York: Ballantyne Books, 1985), p. 138.Google Scholar

8 From this point of view, then, IVF with donor gametes could be more problematic than IVF in which a woman and a man make use of their own eggs and sperm.

9 Corea, Genoveffa, “Egg Snatchers,” in Test-Tube Women: What Future for Motherhood, edited by Arditti, Rita, Klein, Renate Duelli and Minden, Shelley (London: Pandora Press, 1984), p. 37–51.Google Scholar

10 Andrews, “Alternative Modes of Reproduction,” p. 374–77.

11 Gena Corea and Susan Ince report that in the United States in 1985, 42 out of the 54 clinics accepted only married couples. See their “Report of a Survey of IVF Clinics in the U. S.,” in Made to Order: The Myth of Reproductive and Genetic Progress, edited by Spallone, Patricia and Steinberg, Deborah Lynn (Oxford: Pergamon Press, 1987), p. 140.Google Scholar

12 Judith Lorber, “In Vitro Fertilization and Gender Politics,” in Baruch et al., Embryos, Ethics and Women's Rights, p. 118–19.

13 There are comparable barriers to access to donor insemination. See, e.g., Deborah Lynn Steinberg, “Selective Breeding and Social Engineering: Discriminatory Policies of Access to Artificial Insemination by Donor in Great Britain,” in Spallone et al., Made to Order, p. 184–89.

14 See Shuster, Rebecca, “Sexuality as a Continuum: The Bisexual Identity,” in Lesbian Psychologies: Explorations and Challenges, edited by the Boston Lesbian Psychologies Collective (Urbana, IL: University of Illinois Press, 1987), p. 56–71.Google Scholar

15 See Thomas A. Shannon, “In Vitro Fertilization: Ethical Issues,” in Baruch et al., Embryos, Ethics, and Women's Rights, p. 156–57.

16 See Congregation for the Doctrine of the Faith, “Instruction on Respect for Human Life in its Origin and on the Dignity of Procreation: Replies to Certain Questions of the Day” (Vatican City, 1987). This document, of course, also expresses many concerns about the treatment and destruction of embryos, arguments which are not evaluated here.

17 DeMarco, Donald, In My Mother's Womb: The Catholic Church's Defense of Natural Life (Manassas, VA: Trinity Communications, 1987), p. 156–57.Google Scholar

18 Ibid., p. 157; cf. Ronald D. Lawler, “Moral Reflections on the New Technologies: A Catholic Analysis,” in Baruch et al., Embryos, Ethics, and Women's Rights, p. 167–77.

19 Janice G. Raymond, “Fetalists and Feminists: They Are Not the Same,” in Spallone et al., Made to Order, p. 63.

20 DeMarco, In My Mother's Womb, p. 147; my emphasis.

21 Ibid., p. 159.

22 Ann Pappert, “In Vitro in Trouble, Critics Warn,” Globe and Mail, February 6, 1988, p. A1. For a comparable discussion of IVF success rates in France, see Françoise Laborie, “Looking for Mothers You Only Find Fetuses,” in Spallone et al., Made to Order, p. 49–50.

23 Pappert, “In Vitro in Trouble,” p. A14.

24 Williams, Linda S., “No Relief Until the End: The Physical and Emotional Costs of In Vitro Fertilization,” in The Future of Human Reproduction, edited by Overall, Christine (Toronto: Women's Press, 1989), p. 120–38.Google Scholar

25 “What You should Know About In Vitro Fertilization,” in Our Bodies … Our Babies? Women Look at the New Reproductive Technologies (Ottawa: Canadian Research Institute for the Advancement of Women, 1989)Google Scholar; “Current Developments and Issues: A Summary,” Reproductive and Genetic Engineering, 2, 3 (1989): 253.Google Scholar

26 Anita Direcks, “Has the Lesson Been Learned?: The DES Story and IVF,” in Spallone et al., Made to Order, p. 163. For a discussion of the harmful effects of one hormone used in IVF, clomiphene citrate, see Klein, Renate and Rowland, Robyn, “Women as Test-Sites for Fertility Drugs: Clomiphene Citrate and Hormonal Cocktails,” Reproductive and Genetic Engineering: Journal of International Feminist Analysis, 1, 3 (1988): 251–73.Google ScholarPubMed

27 Klein and Rowland, “Women as Test-Sites,” p. 270.

28 “Resolution from the FINRRAGE Conference, July 3–8, 1985, Vallinge, Sweden,” in Spallone et al., Made to Order, p. 211.

29 Sultana Kamal, “Seizure of Reproductive Rights? A Discussion on Population Control in the Third World and the Emergence of the New Reproductive Technologies in the West,” in Spallone et al., Made to Order, p. 153.

30 See, e.g., Sherwin, Susan, “Feminist Ethics and In Vitro Fertilization,” in Science Morality and Feminist Theory, edited by Hanen, Marsha and Nielsen, Kai (Calgary: University of Calgary Press, 1987), p. 265–84.Google Scholar

31 Sandelowski, Margarete, “Failures of Volition: An Historical Perspective on Female Agency and the Cause of Infertility,” Signs: Journal of Women in Culture and Society, 15, 3 (Spring 1990): 498.CrossRefGoogle Scholar

32 Ibid.

33 Peters, Christine St., “Feminist Discourse, Infertility and the New Reproductive Technologies,” National Women's Studies Association Journal, 1, 3 (Spring 1989): 359.Google Scholar

34 Christine Crowe, “‘Women Want It’: In Vitro Fertilization and Women's Motivations for Participation,” in Spallone et al., Made to Order, p. 84–93.

35 See Solomon, Alison, “Integrating Infertility Crisis Counseling into Feminist Practice,” Reproductive and Genetic Engineering, 1, 1 (1988): 41–49Google Scholar; and Pfeffer, Naomi, “Artificial Insemination, In-Vitro Fertilization and the Stigma of Infertility,” in Reproductive Technologies: Gender, Motherhood and Medicine, edited by Stanworth, Michelle (Minneapolis: University of Minnesota Press, 1987), p. 81–97.Google Scholar

36 Lorber, Judith, “Choice, Gift, or Patriarchal Bargain?” Hypatia, 4 (Fall 1989): 30.CrossRefGoogle Scholar

37 Warren, Mary Anne, “IVF and Women's Interests: An Analysis of Feminist Concerns,” Bioethics, 2, 1 (1988): 40–41.CrossRefGoogle ScholarPubMed

38 Raymond, “Reproductive Technologies,” p. 133–42.

39 Ibid., p. 135.

40 Ibid., p. 137.

41 Deborah Poff, “Reproductive Technology and Social Policy in Canada,” in Overall, The Future of Human Reproduction, p. 223.

42 Lorber, “Choice, Gift, or Patriarchal Bargain?,” p. 24.

43 Vicki Van Wagner and Bob Lee, “Principles into Practice: An Activist Vision of Feminist Reproductive Health Care,” in Overall, The Future of Human Reproduction, p. 238–58.

44 Nikki Colodny, “The Politics of Birth Control in a Reproductive Rights Context,” in Overall, The Future of Human Reproduction, p. 43.

45 “Current Developments and Issues: A Summary,” Reproductive and Genetic Engineering, 2, 3 (1989): 253, Wagner's emphasis.Google Scholar

46 Lorber, “Choice, Gift, or Patriarchal Bargain?,” p. 23–26.

47 Burfoot, Annette, “Exploitation Redefined: An Interview with an IVF Practitioner,” Resources for Feminist Research/Documentation sur la recherche feministe, 18, 2 (June 1989): 27.Google Scholar