Book Review: Reproductive Donation - Practice, Policy and Bioethics

Reproductive Donation: Practice, Policy and Bioethics

Edited by John Appleby, Professor Guido Pennings and Professor Martin Richards

Published by Cambridge University Press

ISBN-10: 0521189934, ISBN-13: 978-0521189934

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Assisted conception gives rise to some truly fascinating questions about human reproduction. Conception enabled through donated sperm, eggs, embryos and surrogacy, in particular, open up a vast number of new possibilities. The book 'Reproductive Donation: Practice, Policy and Bioethics', edited by Martin Richards, Guido Pennings and John Appleby provides an overview of the issues relating to donation and also critically engages with related international policy as well as ethical debates.

An impressively vast number of issues are covered, including for example; the history and biology of donation, national policies and international differences, intrafamilial donation, donor recruitment, and single and same sex parenthood. The chapters engage predominantly with these possibilities from an ethical point of view, using psychological research into the wellbeing of families and psychosocial development in donor conceived children as an evidence base. As such, the book will be of interest to policy makers, practitioners and bioethicists.

There is no straightforward answer as to how societies, cultures, families and individuals can or should deal with the new possibilities raised by reproductive donation. Whether and how donation should be regulated and managed, and how to understand and negotiate its ethical implications are questions still being debated. What I found was particularly interesting and useful about this book was the way in which it raises new questions within such debates.

One such example is the issue of donor recruitment discussed by Guido Pennings, Effy Vayena and Kamal Ahuja. In the UK, the supply of donated gametes is low which raises the question of how to get people to come forward as donors, and whether they should be paid. Payment is dealt with in vastly different ways in different countries; in the UK payment is seen as too ethically problematic and donors are not paid.

The authors importantly point out, however, that there is a rather troubling discrepancy between the fact that donors cannot receive payment for their donation and yet there is little regulation in place guiding how much clinics are allowed to charge recipients of donated gametes. The authors raise important questions about how far the ethical framework of altruism extends, who is allowed to make money on donation, and how ethical frameworks in donation are entangled with social, economic and political issues of a wider context.

The book also makes important contributions to the debate on disclosure, genetic relatedness, and whether parents should tell their children about their genetic origins. John Appleby, Lucy Blake and Tabetha Freeman ask whether disclosure is in the best interests of children. A review of the psychological evidence and ethical considerations leads them to argue for a 'cautious and considerate approach to determining whether disclosure is in the best interest of any donor-conceived child'. Moreover, Anja Karnein usefully explores the importance of genetic relatedness for children's wellbeing from a philosophical perspective. Together, these and other authors raise critical questions about the meaning of genetic relatedness and the ethics of disclosure.

The book provides an excellent overview of ethical debates, policy and regulation, however donation also raises a much broader set of social issues in everyday life. For those involved, it might raise concerns about whether lesbian couples will be seen as a family, whether a grandfather will accept a donor conceived child as his grandchild, or whether a donor needs to tell his wife about donating. The issues raised by donation may emerge in complex ways in people's lives, linger and make for uncertain futures.

The voices of people actively involved in or touched by the practice of donation, such as children, donors, parents and practitioners, are curiously absent from this book. The book did perhaps not intend to discuss these more sociological questions and yet it is surprising to find an issue such as reproductive donation, so deeply entangled with human desire, emotions and expectations, discussed in a manner almost removed from the messiness and complexity of living. The real life experiences of those touched by donation would have added an important dimension to an otherwise thought-provoking and rich contribution.

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