Chapter 2 explores the right to make use of medically assisted procreation to conceive a child, upheld by the Strasbourg Court as an expression of private and family life. It discusses limitations based on ‘the rights of others’ (e.g. the other gamete provider in disputes over embryos) and ‘morals’ (e.g. public policy objections to heterologous fertilisation, surrogacy and the posthumous use of cryopreserved gametes/embryos). The chapter argues that the refusal to treat couples with donated gametes imposes a choice between genetic parenthood and the continuance of marriage to an infertile spouse, affecting both prospective and existing family life. It further maintains that reproductive autonomy should extend to posthumous reproduction where the deceased left advance directions and there are no overriding child welfare concerns. The chapter notes the recognition of legal ties between children and genetic parents in foreign surrogacy cases, albeit exclusively through the lens of children’s privacy (identity) rights.

The Introduction provides an overview of the conceptual background and main themes of the book. It briefly considers the advances in assisted reproduction technology (e.g. in vitro fertilisation and pre-implantation genetic diagnosis) and their benefits for aspiring parents. It suggests that these scientific developments not only have led to the emergence of new trends in bioethical politics, but have also inspired claims in the international human rights arena. In fact, an increasing number of legal cases, most notably in the European Convention on Human Rights system, has started to establish a set of rights in connection with access to medically assisted procreation; they are an extension of autonomy rights, the right to respect for family life and non-discrimination rights. The Introduction offers a synopsis of each chapter, outlining the key bioethical and legal controversies examined therein, as well as the central arguments proposed by the book in light of international litigation.

Chapter 5 examines the impact of gender, sexual orientation and civil status on access to ART and the enjoyment of family life formed through ART. Aspiring single parents, women in a relationship with a same-sex or transgender male partner, and men in a same-sex relationship are reliant on gamete donation (as well as, in the case of male couples, surrogacy) in order to have a biological child and are particularly disadvantaged by prohibitions on third-party reproduction. These remain, nonetheless, within States’ margin of appreciation. However, where a child was born following the use of donated gametes or surrogacy abroad, the Strasbourg Court requires measures of protection. Significantly, the relationship of surrogate-born children with the intended non-biological parent is equally protected whether the genetic father has an opposite-sex or same-sex spouse. The chapter criticises, however, the less favourable treatment of commissioning mothers based on a conservative understanding of motherhood as gestational.

This chapter considers the child’s right to identity. It is for good reason that the Convention on the Rights of the Child requires that core aspects of a child’s legal identity are in place soon after birth. A legal identity secures the child’s place in society, nation and family, providing the foundations for the child’s sense of self and relationships with others. The fact that these crucial aspects of identity are put in place when the child is an infant means that particular care must be taken to ensure that the child’s interests are not lost; not least because adults often have powerful interests in the way in which a child’s identity is determined and recorded. This chapter considers the formation of a child’s legal identity through recognition of parenthood and the challenges posed by changing reproductive technology and social norms such as the growth of international surrogacy arrangements. Further, a child’s knowledge of their genetic origins and the circumstances of their birth may be important to their sense of self and personal identity. The extent to which the right to identity incorporates a right to knowledge of origins is also considered.

This chapter evaluates agreements about parentage, for example, surrogacy agreements, agreements with gamete donors, agreements about the division of embryos, coparenting agreements, and equitable parent doctrines. The text explores the states reluctance to delegate power over this legal status.

This chapter aims to provide a survey of the recent and emerging conversations between theology (and more specifically moral theology or Christian ethics) and social anthropology (and more specifically the anthropology of morality). These conversations are presented as starting from two sides, as being a matter of theology attending to anthropology, and of anthropology engaging with theology. Banner’s The Ethics of Everyday Life is taken as providing an indication of the nature and promise of the first conversation for enriching theology’s social intelligence and its self-understanding (illustrated in particular by a discussion the Alder Hey scandal and of reproductive surrogacy), and Robbins’s Theology and the Anthropology of Christian Life is taken as indicating the potential for the second, namely that beyond religious life providing material for ethnography, theological ideas and concepts may contribute to anthropological theory, even in relation to such central categories as the gift. The chapter closes with a consideration of some future directions which these conversations may take.

In the final chapter of the book, I argue that future research in philosophy of parenthood should take either a significantly broader or significantly narrower view of parenthood (or parental rights/obligations). We should not assume that we can use any of these four key concepts of parenthood independently, without taking into account their interrelations with others. We may therefore move forward either by considering problem cases in light of these concepts as an interrelated web (or ‘family’) or by stripping back the questions being asked to investigate more specific concepts. For example, the latter approach to moral parenthood might involve putting aside the widespread presupposition that parental rights and obligations are a concomitant ‘package’ and instead focusing on isolated issues, such as the right not to be separated from one’s biological offspring. The rights and obligations with which philosophers are chiefly concerned should, on this approach, be stripped away from the myth of ‘the parent’ as one straightforward entity with clear and consistent characteristics.

This chapter begins by clarifying the distinction between social parenthood and parenting and explain how the longstanding but malleable association between social and biological parenthood depends upon social and legal conventions determining who is eligible to parent. One way in which to place oneself in that situation is to conceive a child biologically – however, biological parenthood often comes apart from social parenthood. I explore the significance of clinical assistance, money, and distance, in navigating this separation in the context of assisted reproduction. The second part of the chapter incorporates gender into the analysis, looking in detail at the social roles of motherhood and fatherhood, and the interplay of biological parenthood and moral parenthood with the expectations associated with these roles – for example, the effect of the visibility of pregnancy on attributional parenthood, the characterisation of fatherhood as more detached and less sentimental than motherhood, the persistence of associations between fatherhood and breadwinning, and so on. In this chapter, I explore the findings of sociological, psychological, and anthropological research into motherhood and fatherhood in order to demonstrate that one can inhabit a social role comprised in part by normative standards, even if one does not conform to those standards.

This chapter investigates the common presuppositions we make about legal parenthood – for example, the assumption that biological parents are legal parents by default in most jurisdictions. Looking back at some of the ways in which legal rules of parenthood have shifted in recent history, I show that these rules are often more tightly knit with legal structures surrounding marriage and other kinship structures, than with biological parenthood, particularly for men. I examine the problems faced by unmarried fathers who either do not know they have biological offspring or discover this too late to claim legal parental rights. I also discuss the role of the principle of ‘the best interests of the child’ and the conflicts that arise when laws motivated by the best interests of children are broken for the sake of the best interests of a specific child. I then focus on the regulation of adoption and surrogacy in order to illustrate the fragility of distinctions between these practices, in which the difference between parenthood and a criminal offence sometimes hinges on a couple of pieces of paperwork.

Inconsolable distress is neither a universal nor inevitable response to inability to have biological children. In Chapter 14, the author criticizes research with clinic samples that has produced a problem-saturated account of childlessness that obscures a wide range of alternative responses. The author examines the influence of pronatalist ideology on people who are impacted by infertility including many people with sex variations. Away from the treatment context, psychological input can guide individuals, couples and groups to explore personal meaning of nonparenthood. It can facilitate service users to grieve for what is not possible, challenge feelings of deviance and shame, reengage with a range of life goals and, perhaps most important of all, recast adult identities. Through the practice vignette built around a heterosexual couple, one of whom has a late diagnosis of Klinefelter syndrome, the author teases out the difficulties of working psychologically in a treatment context, where complex existential issues and relational dynamics are compressed into the frame of pressurized treatment decisions.

In the 1990s, some former patients mounted street protests in front of medical conferences to draw attention to their trauma. They reclaimed intersex as a personal identity and campaigned for healthcare reform. These developments are the focus of Chapter 5. Intersex is coming out of the closet more and more, through being a topic in television documentaries, novels, films and art. Intersex activists challenge medical authority to change practice. Furthermore, they are not waiting for doctors and scientists to come to their viewpoints. They have successfully lobbied human rights agencies to position childhood genital surgery as a violation of their human rights. They demand that surgery is delayed until the child can give informed consent or is at least old enough to participate in the discussion and offer their agreement.

This chapter considers the more complicated process of becoming a parent when one or both parents is not genetically related to the child, and there is a third party (donor, relinquishing parent, or surrogate) involved. The chapter first sets out the key psychological and social challenges that are shared across all modes of non-biological parenthood, and then examines theory and research evidence on the transition to parenthood for heterosexual couples conceiving with donated sperm, eggs, or embryos, women who choose to embark on parenthood alone, with the assistance of a sperm donor, lesbian couples, gay couples, and those who adopt a child.

This chapter considers the legacy of the 1984 Warnock Report, and its continued impact on the regulation of assisted conception, embryo research and surrogacy in the UK. On the one hand, it is extraordinary that a regulatory system grounded in recommendations made only six years after the birth of the first ‘test tube baby’ has stood the test of time so well. The HFEA regulatory model – in which an ‘arm’s-length body’ issues licences, backed up by criminal sanctions, and in which primary legislation is supplemented by regularly updated codes of practice – has proved remarkably resilient, and has since been used to regulate other areas of medical practice. On the other hand, there may be disadvantages in trying to regulate a twenty-first-century industry using tools that were designed for a very different age. The chapter looks at two developments that the Warnock Report did not anticipate and hence did not make provision for in its recommendations: the emergence of a lucrative market in fertility services; and the increasing acceptance that fertility treatment should be available to would-be parents who do not conform with the ‘two-parent family, with both father and mother’ model.

This chapter reflects on liminality, a guiding concept in the project that brought both authors to Edinburgh and has featured prominently in Graeme Laurie’s most recent work. It introduces the concept of liminality and discusses Laurie’s framing and use of the term before going on to illustrate how both the concept and Laurie’s approach to it have shaped and facilitated further research on the ethics and governance of reproduction. The chapter considers the wider implications of Laurie’s contributions to the field, drawing out some of the key themes of his work on liminality, namely the processual, the experiential and the ‘quality of in-between-ness’. It provides new perspectives by applying these themes to research on the ethics and regulation of surrogacy as well as artificial womb technology. The chapter argues for the relevance of liminality as an analytical framing device, to reveal important lessons for ethics and law beyond the realm of health research regulation. Finally, the opportunity is taken to reflect on Laurie’s guidance as a project leader and the ways in which the authors’ own liminal identities in the project laid the foundation for their future as researchers.

Failure to conceive following 12 months of unprotected intercourse is defined as infertility. Both male and female factors can lead to infertility. Various forms of assisted reproductive techniques with different success rates are available to manage both male and female infertility. In some clearly defined cases gestational surrogacy provides the only hope for a couple to have their own genetic children.

This chapter interrogates practices of biotechnology related to pregnancy and reproduction. Taking note of a recent proliferation of speculative texts about compromised fertility and draconian measures to control women’s reproductive freedoms, alongside continued legislative attempts to restrict access to abortion and other tools of family planning, this chapter asks what it means that we have become so obsessed with the life of the unborn fetus. Through an analysis of practices in the fertility industry, and especially the transnational market in surrogacy services, this chapter reads two speculative fiction works about changed fertility: Jane Rogers’ The Testament of Jessie Lamb and Louise Erdrich’s Future Home of the Living God. It argues that increasingly restrictions that prevent those in the Global North from accessing surrogacy and related fertility services from those in the Global South speak to a perceived crisis in reproductive futurity. The plethora of narratives about a crisis in fertility, then, speak to a racialized anxiety about the scarce “supply” of reproductive capacity: whose fertility and family structures will be preserved into the future?

Chapter 6 examines the allocation of parentage in cases of surrogacy. The chapter seeks to identify a way to regulate surrogacy that adheres to the best interests principle and balances the interests and needs of all stakeholders in the process. It is suggested that an intention-based model of surrogacy, which is facilitated through a pre-conception allocation of parentage, satisfies the requirements of the best interests principle.