Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Children's Bioethics Centre, The Royal Children's Hospital, 50 Flemington Road, Parkville, Melbourne, VIC, 3052, Australia.
J Bioeth Inq. 2024 Mar;21(1):117-129. doi: 10.1007/s11673-023-10281-4. Epub 2023 Oct 13.
The predominant position in the reproductive rights literature argues that access to assisted reproductive technologies (ART) forms part of an individual's right to reproduce. On this reasoning, refusal of treatment by clinicians (via provision) violates a hopeful parent's reproductive right and discriminates against the infertile. I reject these views and suggest they wrongly contort what reproductive freedom entitles individuals to do and demand of others. I suggest these views find their origin, at least in part, in the way we define "reproduction" itself. This paper critically analyses two widely accepted definitions of human reproduction and demonstrates that both are fundamentally flawed. While the process of reproduction includes the biological acts of begetting and bearing a child, I argue that it does not extend to include rearing. This reworked definition has little impact in the realm of sexual reproduction. However, it has significant ethical implications for the formulation and assignment of reproductive rights and responsibilities in the non-sexual realm in two important ways. First, a claim to access ART where one has an intention to rear a child (but does not beget or bear) cannot be grounded in reproductive rights. Second, lacking an intention to rear does not extinguish the reproductive rights and responsibilities for those who collaborate in the process. I conclude that clinicians collaborate in non-sexual reproduction at the point of triggering conception (begetting) and therefore have the right to refuse to be involved in non-sexual reproduction, in some instances, as do all reproductive collaborators.
生殖权利文献中的主要观点认为,获得辅助生殖技术(ART)是个人生殖权利的一部分。基于这一推理,如果临床医生(通过提供服务)拒绝治疗,就会侵犯希望生育的父母的生殖权利,并歧视不孕患者。我反对这些观点,并认为它们错误地扭曲了生殖自由赋予个人的权利和对他人的要求。我认为这些观点至少部分源于我们对“生殖”本身的定义方式。本文批判性地分析了两种广泛接受的人类生殖定义,并证明它们都存在根本性的缺陷。虽然生殖过程包括生育和生育孩子的生物行为,但我认为它并不包括养育。这个经过修改的定义在性生殖领域几乎没有影响。然而,它在非性生殖领域对生殖权利和责任的制定和分配具有重要的伦理意义,主要体现在两个方面。首先,对于那些意图养育孩子(但不生育或生育)而要求获得 ART 的人来说,其诉求不能基于生殖权利。其次,缺乏养育的意图并不会剥夺那些参与该过程的人的生殖权利和责任。我得出结论,临床医生在触发受孕(生育)的那一刻就参与了非性生殖,因此他们有权在某些情况下拒绝参与非性生殖,就像所有生殖合作者一样。