Who Ought to Use ART?

I’m going to interrupt my discussion of West Virginia here just for a moment.   I’ll come back to that later today.  

Last month I wrote about a Newsweek essay focusing on a woman who froze some of her eggs so that she could delay pregnancy and still bear a child with whom she would have a genetic connection.   She did so because although she was getting older, she was not in the circumstances in which she wanted to raise a child.     

Here’s another clip about essentially the same practice.   This one is from Australia.   One woman refers to it what she is doing as “lifestyle egg freezing treatment” and that rather captures what’s troubling me.   The treatment is also apparently known, at least in Australia, as “social egg freezing.”  

This caught my eye because of another story I read several days ago.   This one (off a US website) concerns a practice called “social surrogacy.”   It’s about women who employ surrogacy for social (as opposed to medical) reasons.   In other words, these are not women who are infertile and therefore need to use surrogacy, but are rather women who are too busy to be pregnant or perhaps have jobs where pregnancy would be inconvenient or who do not wish to have their bodies subjected to the physical changes wrought by pregnancy.  

I think this is essentially the same distinction that’s being drawn in the egg freezing scenario above.   Social egg freezing is distinguished from that which is medically necessary.   It’s chosen because it is inconvenient or impractical to become pregnant at the present time.   Implicitly it is to be contrasted to the conduct of a woman who is about to undergo chemotherapy and therefore freezes some of her eggs

More generally, I take these two stories to suggest that we could distinguish uses of ART into those with are social (read optional) and those which are medically necessary.   Unspoken, but fairly clear, is the assertion that medically necessary ART is somehow “better” than social ART. 

This is a distinction that interests me.  At first blush it seems like a significant line to consider.  On one side you have infertile people who are facing circumstances entirely beyond their control–illness and disease–who are using ART to transcend their condition.   On the other side you have people who could manage perfectly well without ART, but who choose to use it because it allows them to live their lives more fully in the present.   (I should add that membership in this category is also limited to those who can afford to make this choice, because typically ART is expensive.)  

Now frankly, when I lay it out like that, it’s hard for me to make a strong case for the people in the second group–the social ART group.   It seems unreasonably self-indulgent to employ expensive and elitist technological solutions in order to avoid the difficult choices most of us have to make.   But at the same time, I am uneasy standing in judgment on someone else in matters like this.  

If I think about it more carefully, I wonder if you can set up the dichotomy as starkly as I did.   It’s nice to be able to imagine a world where we can easily divide people into “blameless and hence deserving victims of illness” on the one hand and “indulgent narcissists” on the other.   But surely it isn’t like that.    

I’m particularly thinking here about what it means to be infertile.  Do we all agree?   How about two perfectly healthy gay men.   They cannot reproduce without assistance, and they may want to use surrogacy.  Are they in the “social surrogacy” category?   Or are they in the blameless ill category?   And what about a single man–straight or gay.   If he uses surrogacy, what category is he in?  

As I answer those questions, I wonder if I am I tacking towards saying that it’s morally okay for a single man to use a surrogate (because he couldn’t get pregnant, no matter what and so needs to use one), but it is not morally okay for a single woman to use a surrogate (because hers is a social surrogacy–she could get pregnant.   Drawing a line like that–a line that so clearly treats men and women differently alarms me.  

None of these questions have easy answers.   After all, who really “needs” to have a baby at all?   But it’s necessary to consider them.  There are larger questions lurking here, questions about who gets to be a parent and how.   This is really only the tip of the iceberg.