Bayefsky Michelle Jessica, Caplan Arthur
Obstetrics & Gynecology, NYU Langone Health, New York, New York, USA
Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York, USA.
J Med Ethics. 2025 May 21;51(6):416-419. doi: 10.1136/jme-2024-109877.
Infertility patients and patient advocates have long argued for classifying infertility as a disease, in the hopes that this recognition would improve coverage for and access to fertility treatment. However, for many fertility patients, including older women, single women and same-sex couples, infertility does not represent a true disease state. Therefore, while calling infertility a 'disease' may seem politically advantageous, it might actually exclude patients with 'social' or 'relational' infertility from treatment. What is needed is a new conceptual framing of infertility that better reflects the profound significance of being infertile for many people and the importance of addressing infertility in order to improve their lives. In this paper, we argue that the capability approach provides this moral underpinning. The capability approach is concerned with what people are able to , and whether they are able to act in a way that is in keeping with their own values and goals. The ability to procreate and build a family is a fundamental capacity and can be a major part of self-fulfilment, regardless of sexual orientation or family arrangement. Since the capability approach asks us to conceive of equality in terms of equal capabilities, it provides a strong ethical impetus for society to help those who cannot conceive on their own to do so with assisted reproduction.
不孕不育患者及其倡导者长期以来一直主张将不孕不育归类为一种疾病，希望这种认可能够改善生育治疗的覆盖范围和可及性。然而，对于许多不孕不育患者，包括老年女性、单身女性和同性伴侣来说，不孕不育并不代表一种真正的疾病状态。因此，虽然将不孕不育称为“疾病”在政治上可能看似有利，但实际上可能会将患有“社会”或“关系性”不孕不育的患者排除在治疗之外。我们需要一种新的不孕不育概念框架，以更好地反映不孕不育对许多人的深远意义，以及解决不孕不育问题对改善他们生活的重要性。在本文中，我们认为能力方法提供了这种道德基础。能力方法关注的是人们能够做什么，以及他们是否能够以符合自己价值观和目标的方式行事。生育和组建家庭的能力是一种基本能力，并且无论性取向或家庭安排如何，都可以是自我实现的重要组成部分。由于能力方法要求我们从平等的能力角度来构想平等，因此它为社会提供了强大的道德动力，促使社会帮助那些无法自行受孕的人通过辅助生殖来实现受孕。
