Book Review: Reproductive Donation

Reproductive Donation: Practice, Policy and Bioethics

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

Published by Cambridge University Press

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

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Donor conception continues to mobilise resistance and concern. How, when, under which conditions and by whom reproductive donation should be accessed remains a divisive and controversial issue. Political debate, media coverage and public conversation have not always excelled at incorporating evidence. Arguments often focus on sweeping emotive statements about motherhood, ancestry and human nature. When more specific claims are made, they often lack any grounding in evidence and are in fact attempts at dressing up those same emotive claims in the furs of academic legitimacy. The Northern Ireland health minister's claim that children in gay families are far more likely to be abused is a recent, and especially toxic, example of this.

'Reproductive Donation' challenges the ideas that lie behind such claims with bioethical discussion and social-science evidence. It is a highly important contribution to the conversation. The editors, all in some way connected to the Centre for Family Research at Cambridge University, have done a great job at keeping their selection broad yet focused. In seventeen chapters, the authors pick through different aspects of reproductive donation, from basic biology and ethics to anonymity and international regulation. They explore the history of donor conception, discuss past and present issues and weigh up the arguments for and against. They do so by presenting what little (but growing) evidence there is to see what actually matters to people in the thick of it: parents, donors, children and their families. It is systematic and thorough, and at times presents genuinely surprising evidence. The chapter on embryo donation (by Fiona MacCallum and Heather Widdows) discusses how the moral status of the embryo in the eyes of the couple impacts on what they choose to do with surplus embryos at the end of treatment. That in itself is not surprising. But what did surprise me was that viewing embryos as already having personhood makes parents less likely to donate them and more likely to let them be discarded. The reasoning behind these decisions was unexpected and fascinating, showing how people can give very different meanings to the situations presented by new technologies.

'Reproductive Donation' thus makes a fantastic policy textbook that will hopefully make its way to the shelves of campaigners and decision makers alike. It is also great reading for anyone interested in evidence-based approaches to donor conception, and a helpful aid for those considering involvement in reproductive donation as parent, donor or surrogate. Too much information out there is supplied by people with well-hidden agendas, and a book like this can be a powerful tool for negotiating the complex dilemmas parents and donors can face.

Possibly as a consequence of its mission to inform policy on reproductive donation, however, the book fails to incorporate alternative ways of thinking about reproduction and family. It misses opportunities to challenge the way technology might be pushing us further into the pursuit of the two-parent biological family norm, potentially pressuring people to try to match that norm at all cost. There is no denying the deeply felt need for assisted conception. Those with fertility problems, as well as same-sex and single people, often wish to have families of their own, and they should be able to pursue that dream. Expecting them to transform social understandings of the role and nature of family would be an unfair burden. Yet some are doing just that. There are those who decide not to have children at all or to become involved aunts and uncles, there are those who foster, adopt or co-parent. None of these directly fall under the topic of 'reproductive donation', but they form part of a wider context within which these technologies exist. Coverage of alternatives to assisted conception would have perhaps helped readers keep in mind that it is only one of several ways to approach the inability to have children.

There is also the issue of evidence. As the authors point out, evidence can only be gathered for procedures that can be performed. Even then, it takes many years to be able to make claims about the effects of such procedures on children. The enduring secrecy that often surrounds assisted conception complicates things further. Therefore, much of the evidence quoted in 'Reproductive Donation' is far from perfect. The samples are small and often biased, meaning that the results may not be reliable. The authors are open about such challenges and try to back up small studies with other similar ones and make the best out of what little evidence there is.

The result is a book that establishes donor conception as a viable and increasingly common way of creating families – one that is here to stay and that needs to be openly dealt with. We can only hope that, as more and more children grow up knowing their donor origins and the general focus on secrecy continues to lift, there will be a second volume to add to this important collection.

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