Patriarchal Bargains

In the beginning, when medically assisted reproduction (MAR) was still just a promise for the future, it seemed to have the potential of liberating women from the 'tyranny of biology' (Firestone, 1972; Toffler, 1970). But to what extent has it in fact empowered women and expanded their realm of choice? On the one hand, individuals have been creative in using the technology to shape new forms of family and kinship relations. On the other hand, we see the fragmentation of women's reproductive roles; the objectification of their bodily functions; the commodification of their body parts (wombs and eggs); and the stratification of designated parents and reproductive laborers (the mother and the other). We also see a global market that divides women into have- and have-nots, with global elites being serviced by less fortunate women, and patterns of exploitation of the latter in ways that can amount to trafficking in human beings and their body parts.

Despite the change in the social status of women around the world, voluntary childlessness remains rare. To the contrary, the use of reproductive technology is becoming a normative imperative, which means that a choice to abstain is more difficult than a choice to collaborate, and amounts to a form of dissidence. This creates relationships of dependence between the desperate women and their physicians, which are often gendered.

MAR is used within existing power structures and serves to perpetuate deep-set habits of patriarchal relations. Moreover, its joining with the so-called genetic revolution, results in the materialization, biologization and reification of normative family relations, through the idealization of genetics. The value of genetic connection remains stronger than ever in kinship, and this implies the triumph of a male model of reproduction (genetic parenthood) over a female model (genetic, gestational and social), of 'nature' over 'nurture'.

Social solutions for male infertility, such as divorce and remarriage, are a cheaper solution in terms of economics, but have a negative effect on women's social status. Another traditional solution – the fostering of the child of a sibling (brother or sister), i.e. open adoption – does not answer the perceived need for genetic parenthood. Thus, women submit to arduous medical interventions as a kind of patriarchal bargain. Their bodies are instrumentalised in mediating medical technology so as to perpetuate male genetic lineage, while female reproductive roles are devalued.

• If IVF was first designed to overcome female infertility (blocked fallopian tubes), it is now used, as often, for ICSI (sperm micro-manipulation) as the standard treatment for male sub-fertility, instead of artificial insemination with donor sperm which fails to answer the genetic imperative.
• In reproductive cloning, eggs are rid of genetic content. In a symbolic sense cloning reduces the female egg into a passive vessel rather like the womb.

An ethic of care

For the most part, repro-genetic technology is driven by for-profit market forces and played out through the greed of medical entrepreneurs, and the desire of consumers masquerading as individual choice. The discourse of consumerism is one in which the language of 'want' translates into 'need', which then turns into a sense of entitlement and the assertion of a 'right' to parenthood), together with a demand for immediate gratification (Sacks, 2002).

The language of 'right' is a misnomer. Strictly speaking, a 'right' as such exists only by virtue of contract in relation to a duty holder. And as for human 'right's, these have universal application regardless of personal economic resources, while the market is an arena of 'privilege' for those with the ability to pay, from either personal or collective resources.

The hype of repro-genetics creates false and misleading impressions about the endless possibilities of western scientific medicine. But the availability of medical fixes for childlessness does not altogether relieve the suffering associated with infertility and reproduction. Technological fixes create new pressures, fears, anxieties and forms of suffering, which require in turn more technological fixes. Women experience the physical demands of infertility treatment, and the despair of dashed hopes from repeated unsuccessful cycles. They carry a new burden of blame: that of women who 'get children too late'. There is also 'genetic anxiety' around pregnancy since they feel obliged to do the utmost to produce a 'perfect' healthy child.

It is clearly insufficient and unwise to suffice with a critique of technology. Rather we need to offer an alternative. Perhaps it is time to move on from our ethic of individual freedom, and add to it an ethic of care that is non-judgmental, relational and responsive. I do not mean an ethic of experts, but an ethic of the lay person that goes beyond individual self-interest, appreciates the moral and relational context of repro-genetic decisions, and cares about others who assist in the enterprise of bringing a child into the world. The power of wealth and the privilege of choice seem to call for a response-ability. Repro-genetic choices are not strictly medical but have social and moral implications; so too 'informed' consent to undergo medical treatment could be based on an understanding of the non-medical aspects.

A spiritual dimension

The very nature of human 'being' is affected by the triangular inter-relationship between human beings, technology and nature. In our imagination of the 'post-human' world, reproduction changes from an act of love into a transaction of money, while the future child ceases to be a gift and becomes a project (Sandel, 2007). This is the world portrayed in the movie Gattaca.

A culture of technology epitomizes our faculty of reason, and it is materialistic. At the same time it is impersonal and alienating. In our present world, there are two new forms of human life that are dependent on medical technology: at the beginning of life – frozen embryos; and at its end – people with impaired cognitive ability on artificial life support. Such phenomena call for a fresh look at the meaning of 'life', and the notion of 'human dignity'.

The technological proliferation has a life of its own. It is seductive and irresistible. But what we really need is more lo-tech (tender loving care) rather than hi-tech (machines). We need to cultivate a wisdom of the heart rather than the head, so that we are able to use skillfully the marvels of our technological world. There is much suffering from repro-genetic technology. There is ignorance in believing that it can provide a solution for any personal predicament. We need to understand that we cannot control life, since uncertainty is intrinsic. We need to understand that our desire for gratification is a greed that can never be fully satisfied. And we need to understand that our lives are interconnected in a seamless web of relations with others.

It seems that our emotional intelligence is lagging behind our reason. The technological state of mind is a limited consciousness. It cannot appreciate those essential dimensions of human being that are not quantifiable or measurable but constitute human dignity. An ethic of responsible self-restraint requires a shift in consciousness: from calculation to contemplation, or from outer observation of seemingly external objects and things to inner awareness of the seamless web of nature-human-technology in which we are actors. Human dignity may be understood as an inner state of mind that is the responsive and caring self-reflection of the autonomous actor, rather than the observed attributes of the other upon which he or she acts.