Chapter 2 explores the right to make use of medically assisted procreation to conceive a child, upheld by the Strasbourg Court as an expression of private and family life. It discusses limitations based on ‘the rights of others’ (e.g. the other gamete provider in disputes over embryos) and ‘morals’ (e.g. public policy objections to heterologous fertilisation, surrogacy and the posthumous use of cryopreserved gametes/embryos). The chapter argues that the refusal to treat couples with donated gametes imposes a choice between genetic parenthood and the continuance of marriage to an infertile spouse, affecting both prospective and existing family life. It further maintains that reproductive autonomy should extend to posthumous reproduction where the deceased left advance directions and there are no overriding child welfare concerns. The chapter notes the recognition of legal ties between children and genetic parents in foreign surrogacy cases, albeit exclusively through the lens of children’s privacy (identity) rights.

The Introduction provides an overview of the conceptual background and main themes of the book. It briefly considers the advances in assisted reproduction technology (e.g. in vitro fertilisation and pre-implantation genetic diagnosis) and their benefits for aspiring parents. It suggests that these scientific developments not only have led to the emergence of new trends in bioethical politics, but have also inspired claims in the international human rights arena. In fact, an increasing number of legal cases, most notably in the European Convention on Human Rights system, has started to establish a set of rights in connection with access to medically assisted procreation; they are an extension of autonomy rights, the right to respect for family life and non-discrimination rights. The Introduction offers a synopsis of each chapter, outlining the key bioethical and legal controversies examined therein, as well as the central arguments proposed by the book in light of international litigation.

This chapter begins with a discussion of the common methodologies, starting assumptions, and key aims that shape philosophical work in this sphere. This part of the chapter aims to lay bare the bones of philosophy of parenthood as this field currently stands, providing a critical tool for investigation of existing theories of parenthood, but also further demonstrating the complex interdependence between moral parenthood and the concepts of parenthood covered in the previous chapters. I then give an overview of the approaches philosophers have taken to defining the grounds of moral parenthood, and the different problem cases motivating these accounts. Whilst all these problem cases deviate from the ‘paradigm’ case – in which biological, social, legal, and moral parenthood neatly coincide – literature on parental obligations tends to focus on situations in which candidate parents are disinclined to take on some form of parenting role. Philosophers focusing on parental rights, on the other hand, have often been concerned with an overabundance of candidate parents and have aimed to provide solutions to potential disputes. These disputes might arise between parties to surrogacy agreements, biological parents and step- or adoptive parents; and, more speculatively, between biological parents and the hypothetical ‘best available parents’.

Direct-to-consumer (DTC) DNA testing has had a major impact on people affected by donor conception, including donor-conceived people, their parents, and donors. It has enabled people to discover their conception status and to identify the donor. Donors who were assured of anonymity and their extended families are being contacted by their donor offspring and recipient parents. Consequently, it is now impossible to assure donors they will be anonymous, and parents can no longer consider that nondisclosure of donor treatment to their children is a viable option. Fertility counselors need to prepare their clients for the implications of DTC DNA testing, be fully informed of the repercussions faced by donor-conceived adults, especially those finding out their conception status past childhood, and also to have donor-linking skills as part of their counseling tool kit.

The right to know one’s genetic origins should not be recognised as a moral right because it protects no important interest. The knowledge of one’s genetic origin is neither sufficient nor necessary for the construction of one’s identity. The suffering of some donor-conceived people is based on the misconception that this knowledge is necessary. The empirical evidence generated by psychological research on donor-conceived families has shown convincingly that not knowing that one is donor conceived and knowing about one’s donor conception but not knowing one’s donor does not lead to significant differences in psychological well-being and family functioning. A new argument by some people who favour donor identifiability is that donor anonymity can no longer be guaranteed. Although correct, this fact has no implications for the normative claim about the right to know. If anonymity was agreed between donor and recipients, this agreement should be respected even when, or especially when, it can be broken.

Medical Ethics is increasingly recognised to be central to Good Medical Practice and the field of reproductive medicine presents some of the most challenging and complex issues of any branch of medecine. Scientific progress in ART has advanced so rapidly that Ethicists struggle to keep pace, but fertility clinicians can help to bridge the gap between clinical care and the sometimes ‘sci-fi’ world of the embryology laboratory. They can help patients benefit from developments that offer would-be parents the chance of a family without the risk of genetic disease and thereby advance one of humanity’s major goals. Society too is entitled to be engaged in the debate: the transition in just 42 years from in vitro fertilisation being a way of by-passing blocked Fallopian tubes to egg donation, egg freezing, womb transplantation, posthumous reproduction and CRISPR gene editing has raised issues that legislators struggle to explain and some faith groups strive to contain. As clinicians, we are confronted with the patient in the consulting room whom we long to help. We face a difficult balancing act between what is technically feasible, what is practically possible and what is ethically acceptable given resource and other restraints.This chapter is intended to help fertility clinicians achieve that balance.