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Commentary on Nicola Williams and Stephen Wilkinson: ‘Should Uterus Transplants Be Publicly Funded?’
  1. Mianna Lotz
  1. Correspondence to Dr Mianna Lotz, Dept of Philosophy, Macquarie University, Building W6A, Balaclava Road, Sydney, NSW 2109, Australia; Mianna.Lotz{at}

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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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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • i This recognition on their part is more compelling than their accompanying defence of infertility (especially absolute uterine factor infertility (AUFI)) as after all a pathology and genuine medical condition or ‘disorder’ involving subnormal functioning or absence of a bodily part or process.

  • ii It is surely implausible that the State could have an obligation to enable individuals to fulfil an alleged interest in “found[ing] a family in the way they desire”, as seems to be entertained by Williams and Wilkinson at one point.

  • iii I disregard the last option, however, as it cannot be defensibly claimed that only genetic and gestational parenthood offer a ‘journey to parenthood’ and so I find Williams and Wilkinson confusing on this point.

  • iv I acknowledge that of course not all of these barriers can be removed.

  • v Adoption will never be sufficient to provide all would-be parents with a child to raise, and for that reason, some ART such as in vitro fertilisation will remain available, and potentially also surrogacy (albeit with changed laws and other exploitation-minimising conditions that I do not have space to review here).

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