AbstractWhile the literature on oncofertility decision-making was central to the bioethics debate on social egg freezing when the practice emerged in the late 2000s, there has been little discussion juxtaposing the two forms of egg freezing since. This article offers a new perspective on this debate by comparing empirical qualitative data of two previously conducted studies on medical and social egg freezing. We re-analysed the interview data of the two studies and did a thematic analysis combined with interdisciplinary collaborative auditing (...) for empirical ethics projects. Despite their different contexts, major similarities in women’s decision-making and reasoning were found. We developed two main common themes. Firstly, women felt a clear need to plan for future options. Secondly, they manipulated decision-times by postponing definitive decisions and making micro-decisions. The comparison highlights that the passage of time and the preservation of future choice seems to permeate all aspects of the patient experiences in both studies. As a result of considering real-world lived experiences, we suggest that there are many overlaps in women’s reasoning about egg freezing regardless of why they are making a decision to freeze. These overlaps are morally relevant and thus need to be further integrated into the existing arguments that have been canvassed in the flourishing egg freezing and fertility preservation debates across the field, and in policy and practice globally. (shrink)

Non-medical egg freezing is egg freezing for the sake of delaying parenthood. The label ‘non-medical’ can be confusing, since the extraction and freezing of eggs is undeniably a medical procedure. The point is that whereas ‘medical egg freezing’ is done in order to retain capacity to procreate despite a potentially threatening medical condition, ‘non-medical egg freezing’ is done for the sake of getting more time to find a suitable partner and/or to establish a career before embarking on parenthood. One type (...) of argument against NMEF is the individualisation argument, according to which NMEF is problematic in virtue of being an individual solution to a social problem. The underlying problem that ought to be targeted, it is argued, is the patriarchal structures in the labour market, which disprivilege women and make it excessively difficult to combine a work and parenthood. In “Arguments on thin ice”, Thomas Søbirk Petersen helpfully distinguishes between three variants of the individualisation argument: the non-address view, the distraction view and the further oppression view.1 Petersen argues, moreover, that none of these is convincing, and therefore that the rejection of NMEF is unwarranted. According to the non-address view, the reason NMEF ought to be rejected is that “it cannot address the social causes that make it so difficult to balance career and family”2 or that it “does not substantially alter the social structures that have constructed inequalities”3 between women and men. Petersen …. (shrink)

This paper calls for the development of a method of ectogestation as an emancipatory intervention for women. I argue that ectogestation would have a dual social benefit: first, by providing a gestational alternative to pregnancy, it would create unique conditions to reevaluate one’s reproductive preferences—which, for women, always include gestational considerations—and to satisfy a potential preference not to gestate. Enabling the satisfaction of such a preference is particularly valuable due to the pressures women face to embrace pregnancy as central to (...) their identity, while at the same time being penalised by it. Second, ectogestation would address certain specific negative social implications of gestation and childbirth, which cannot be avoided through social measures as they are caused by the corporeal nature of these phenomena. Finally, I argue that it is unfair to hold ectogestation to a higher standard than other innovations such as modern contraceptives and non-medical egg freezing. (shrink)

In the name of safeguarding public interests and ethical principles, China’s National Health Commission bans unmarried women from using assisted reproductive technology (ART), including egg freezing. Supported by local governments, the ban has restricted single women’s reproductive rights nationwide. Although some courts bypassed the ban to allow widowed single women to use ART, they have not adopted a position in favour of single women’s reproductive autonomy, but quite the contrary. Faced with calls to relax the ban and allow single women (...) to freeze eggs electively, the National Health Commission refused to amend their policy, partly to protect women’s well-being paternalistically and partly to implement the central government’s policies to boost the birthrate and maintain traditional family structures. While the government’s concerns about elective egg freezing are not entirely unfounded, they have failed to demonstrate that banning single women’s egg freezing is a suitable, necessary and proportionate means to safeguard societal interests and ethical principles. The authority’s assumptions that women cannot make rational decisions for their health even with adequate informed consent procedures, that banning egg freezing by single women promotes a culture of having children ‘at a proper age’, and that egg freezing by single women offends China’s public moralities have not been substantiated. (shrink)

Olaf (from Disney’s Frozen 2 ) has a theory about advancing technologies being both our saviour and our doom. While we ought to avoid over-analysing claims of fictitious snowmen, we can pause to consider whether it is possible for an advancing technology to be both our saviour and our doom. I will maintain that it is. But for now, note how it is tempting to resolve the overlap by thinking about advancing technologies and individuals. In a possible reformulation of Olaf’s (...) claim, advancing technology can be one person’s saviour, but in being so, is another person’s doom. This reformulation is a type of an ‘individualisation argument’ against advancing technology. Specifically, it is the claim that while an individual’s use of technology may solve their iteration of a problem, it may also undermine a societal response to the broader problem. Peterson, in this edition’s Feature Article, has this type of ‘individualisation argument’ in his sights when he considers its application to non-medical egg freezing (NMEF). That is, freezing an egg for social reasons (such as, to provide for more time to find a partner and/or to establish a career before embarking on parenthood) rather than medical reasons (such as, to treat a potentially threatening medical condition). Peterson formulates the ‘individualisation argument’ in the following way1: > P1: It is morally wrong to let individuals use technology X—in order to try to handle a problem that is social in nature—if the use of X will somehow work against a social solution to a social problem P. > > P2: If individuals make use of a technology like …. (shrink)

BackgroundDuring the last decade, the possibility for women to cryopreserve oocytes in anticipation of age-related fertility loss, also referred to as social egg freezing, has become an established practice at fertility clinics around the globe. In Europe, there is extensive variation in the costs for this procedure, with the common denominator that there are almost no funding arrangements or reimbursement policies. This is the first qualitative study that specifically explores viewpoints on the (lack of) reimbursement for women who had considered (...) to uptake at least one social egg freezing cycle in Belgium.MethodsTo understand the moral considerations of these women, drawing from twenty-one interviews, this paper integrates elements of a symbiotic empirical ethics approach and thematic analysis.ResultsWe identify four themes: (1) being confronted with unclear information; (2) financial costs as ongoing concern; (3) necessity of coverage; (4) extent of reimbursement. In the first theme, we found that some women were concerned about the lack of clear information about the cost of social egg freezing. In the second theme, we report moral sentiments of injustice and discrimination which some women attributed to their struggles and needs not being recognised. The third theme illustrates diverse views on reimbursement, ranging from viewing social egg freezing as an elective treatment not appropriate for reimbursement to preferences for greater public responsibility and wider access. Finally, we describe the participants’ varying proposals for partial reimbursement and the idea that it should not be made available for free.ConclusionsThis research adds important empirical insights to the bioethics debate on social egg freezing, in particular by presenting (potential) users’ views on the lack of reimbursement. While there is much more to say about the ethical and political complexities of the reimbursement of this procedure, our study highlighted the voices of (potential) users and showed that at least some of them would welcome the coverage of SEF through the public healthcare insurance. (shrink)

I am happy to comment on T S Petersen’s1 examination of the ‘individualization argument against non-medical egg freezing ’. Petersen intervenes in the ethical discussion on egg freezing by critically reconsidering a specific type of argument against oocyte cryopreservation for reasons that are not directly related with medical issues. Petersen dissects the claim that such non-medical usage is ‘an individualistic and morally problematic solution to the social problems that women face, for instance, in the labour market’.1 Proponents of this argument (...) believe that egg freezing should not be used by women on an individual level to solve social problems but that one should instead address gendered inequalities on the labour market. Petersen asserts that this individualisation argument is unconvincing—although morally appealing—because of empirically and ethically flawed assumptions. I am enthusiastic—with some minor reservations—about his unravelment of the individualisation argument and his call for more empirical backing. As I understand his presentation, the argument that is the subject of Petersen’s analysis is a recurring argumentative trope in the broader realm of assisted reproduction ethics. For instance, the anticipated positive effect of artificial womb technology in terms of liberation from reproductive and related social inequalities is one of the most dominant ectogenesis …. (shrink)

Recently, Petersen provided in this journal a critical discussion of individualisation arguments in the context of social egg freezing. This argument underlines the idea that it is morally problematic to use individual technological solutions to solve societal challenges that women face. So far, however, there is a lack of empirical data to contextualise his central normative claim that individualisation arguments are implausible. This article discusses an empirical study that supports a contextualised reading of the normative work of Petersen. Based on (...) a qualitative interview study, we found that most women could make sense of this argument but addressed other concerns that are overlooked in the premises of moral individualisation arguments, for instance, the influence of relationship formation on the demand of egg freezing. Furthermore, women did not experience social egg freezing as morally problematic. Nonetheless, the interviewees pointed to a need of more societal solutions and even actively advocated for efforts to increase accessibility such as a partial reimbursement and better quality of information. The implications of these findings for empirical bioethics are discussed. While more research is needed, we argue that, in order to better address individualisation arguments and related ethical concerns, we need to contextualise normative evaluations within women’s moral reasoning. (shrink)