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Disentangling the individualisation argument against non-medical egg freezing from feminist critiques
  1. Lisa Campo-Engelstein
  1. Institute for Bioethics & Health Humanities, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
  1. Correspondence to Dr Lisa Campo-Engelstein, Institute for Bioethics & Health Humanities, The University of Texas Medical Branch at Galveston, Galveston, TX 77550, USA; licampoe{at}utmb.edu

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According to Petersen, ‘the individualization argument against NMEF [nonmedical egg freezing]’ states: ‘it is morally wrong to let individuals use technology X [NMEF] – in order to try to handle a problem that is social in nature – if the use of X [NMEF] will somehow work against a social solution to a social problem P [gender inequality in the labor market]’. While there may be individuals making individualisation argument against NMEF, I do not read the scholars he discusses—Karey Harwood,1 2 Lynn Morgan, Janelle Taylor3 and Angel Petrapanagos4—as making this argument. These scholars agree with the premise of the individualisation argument that NMEF ‘is an individualistic and morally problematic solution to the social problems that women face’ (p. 4), but this does not mean that they agree with the conclusion ‘women should not use NMEF’ (p. 4). In fact, several admit that NMEF can be a good choice for some women; Petropanagos, for example, states ‘individual women may benefit from egg freezing to satisfy their reproductive desires’.4 In this commentary, I argue that Petersen incorrectly reduces these scholars’ positions to the individualisation argument by neglecting three pertinent factors: their feminist orientation, their multifaceted critiques of NMEF and how the rapidly advancing field of reproductive medicine informs their ethical analysis.

While Petersen notes that the authors he discusses are ‘deeply motivated by a very sympathetic concern with improving the lives of women by changing social structures in a way that will increase women’s opportunities to thrive in (among other things) the labour market’ (p. 8), he does not name them as feminist scholars. Perhaps such a label seems obvious, but explicitly recognising these authors’ feminist orientation sheds light on why I do not think they are making an individualisation argument: they are beginning with a fundamentally different question. The individualisation argument asks whether NMEF is morally permissible even if it hinders social solutions to gender inequality, which requires weighing whether NMEF will increase equality more than it will decrease it. Such calculations pit the interests of the individual against the interests of society and the individualisation argument ultimately favours curtailing the rights of individuals to prioritise social solutions.

In contrast, these feminist scholars ask: why is NMEF a problematic approach to combating gender inequality despite portrayals of it as enhancing women’s reproductive autonomy? This question does not assume an oppositional relationship between individuals and society, but instead allows the conceptual space to analyse how NMEF engages with systems of oppression without having to delineate the morality of individuals using NMEF. Reproductive freedom is central to feminist theory, so the paternalistic conclusion of the individualisation argument—it is ‘morally wrong for individuals [read: women] to use NMEF’ (p. 5)—seems discordant with feminist values. Perhaps this is merely a matter of semantics, but I think it reflects the different tone and approach used by feminist scholars. Given the myriad ways systemic sexism inhibits women’s opportunities and freedoms, many feminist scholars are reluctant to make recommendations that deny women’s autonomy and to be prescriptive about how women should lead their lives. Even when women make choices that reinforce patriarchal norms, as NMEF may do, there remains ‘a deep respect for pluralism and self-determination’ (p. 255).5

Rather than the individualisation argument, here is the position I see these feminist scholars taking:

P1: NMEF is being portrayed as a panacea for gender inequality.

P2: NMEF alone will not engender gender equality, and it may impede social solutions to gender inequality.

C: We (as a society) should take a holistic approach to combating gender inequality that includes social solutions, not just technological solutions, and we should be cautious about how NMEF is portrayed and used within our society.

Whereas the individualisation argument treats individual, technological solutions (ie, NMEF) and social solutions as mutually exclusive and adversarial strategies for addressing gender inequality, this formulation does not force us to choose between them—a position that Petersen supports, claiming that ‘we should direct resources (time, effort, funding etc.) both to helping individual women gain reproductive autonomy and improving the labour market in a way that gives more women opportunities’ (p. 13).

In focusing so much on the presumed dichotomy between individual and social solutions to gender inequality, Petersen seems to overlook the multifaceted nature of these scholars’ arguments. Their analysis of NMEF goes beyond it being a technological solution to a social problem to include factors such as safety, cost, efficacy, lack of long-term data and false hope. These are not minor concerns, and when the scholars he cites wrote about this topic, they were even more significant concerns. The field of reproductive medicine is rapidly evolving, and it was not until 2012 that the American Society for Reproductive Medicine (ASRM) lifted the experimental label on egg freezing for any reason (medical or nonmedical); Morgan and Taylor3 wrote the paper a mere 6 months later, and Harwood’s2 first paper on the topic was published 3 years prior in 2009. The Canadian Fertility and Andrology Society did not condone NMEF until 2014 (Petrapanagos published in 20154), and ASRM waited until 2018 (Harwood’s second paper came out in 20171).1 All of these scholars are writing in the North American context, and it seems reasonable for them to have hesitations about NMEF when their professional societies opposed NMEF for these same reasons. My formulation of their argument accommodates these other reasons by recognising that the media and some fertility clinics are heralding NMEF as the solution to gender inequality (P1) and suggesting caution in the portrayal of NMEF and regarding clinical and policy considerations (C).

In short, these scholars’ positions cannot be reduced to the individualisation argument. In order to paint a complete picture of their view, we need to include all of the considerations they discuss (NMEF as a technological solution being one of them) and recognise the complex interplay among these considerations. Additionally, we need to explicitly acknowledge their feminist lens to understand how the questions they ask, the values they prioritise and the positions they take are different from the individualisation argument.

References

Footnotes

  • Contributors LC-E is the sole author of this work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • The European Society of Human Reproduction and Embryology was the first to condone NMEF in 2012 in part due to cultural values.6

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