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Human reproduction is a profoundly social phenomenon, deeply embedded in complex social norms and aspirations. This is most apparent where it is mediated by technology and policy. As such, reproductive technology must be examined fully in light of its wider social impacts, as embodying and communicating significant values, and as occurring within a dynamic and reciprocal communicative relationship between state, society and individual. Williams and Wilkinson offer an extremely useful exploration of issues central to the question of whether uterus transplantation (UTx), once safe and reliable, could be a candidate for public health funding. Yet, in spite of considerable merits, I suggest that their analysis needs supplementation by greater attention to key social factors and impacts inextricably bound up with UTx provision.
One strength of Williams’ and Wilkinson's analysis is their rejection of the claim that UTx funding is unjustified because infertility is not a ‘disease’ or medical condition, but rather a social and ‘culturally determined’ problem, arising only in the presence of certain desires. To this, Williams and Wilkinson persuasively respond by arguing both that ‘…the fact that the major harms associated with infertility are dependent on the desire to have children does not mean that infertility cannot be a pathological condition’; and (more compellingly) that ‘…there may be instances in which it is appropriate for the state to use its resources to address issues other than disease’. This highlights a critical point: decisions regarding public health funding ought not to treat social factors as automatic grounds for disqualification. So many of the harms of accepted ‘diseases’ and ‘disabilities’ turn out on closer analysis to arise in virtue of social factors, including desires, preferences and priorities, rather than purely medical ones. This is part of what it means to say that notions of health and well-being, and their counterparts …
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