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Thursday, December 18, 2014

Uterus Transplants for Transgender Women?

Earlier this year, Swedish clinicians reported a live birth to a woman who had a uterus transplant.

That success opens the door to gestation for other women who cannot gestate a child. 

But are women who were born without a uterus or who have lost a uterus to disease the only candidates for uterus transplantation?

What about uterus transplantation for transgender women?  Transgender women are not born with a uterus, but some might want a uterus in order to gestate a child, in the same way that many non-transgender women do.

What about uterus transplantation for men? for men who would like to gestate a child? If they used their own sperm, they would be the gestational mother of the child and also be the genetic father of the child.


I have just published an article that explores some of the questions that would come up in trying to offer transgender women and men the option of uterus transplant. For one, only a focused line of research would make that possible, if it is possible. Who should pay for such research? the government? And should anybody be doing this kind of research at all?

Some critics don't like the idea of using government money to develop uterus transplantation for men -- and maybe not even for transgender women,but I don't think their argument succeeds. Changing technologies are opening new prospects for becoming parents. I'm not saying that the state must fund uterus transplantation as a top priority for transgender women or men, but I do not think there's any good reason to think the government should never fund that research.

Here's the formal summary of my article, which came out yesterday.

Timothy F. Murphy, Assisted Gestation and Transgender Women, Bioethics 2014 (Dec 17).
DOI: 10.1111/bioe.12132


Developments in uterus transplant put assisted gestation within meaningful range of clinical success for women with uterine infertility who want to gestate children. Should this kind of transplantation prove routine and effective for those women, would there be any morally significant reason why men or transgender women should not be eligible for the same opportunity for gestation? Getting to the point of safe and effective uterus transplantation for those parties would require a focused line of research, over and above the study of uterus transplantation for non-transgender women. Some commentators object to the idea that the state has any duty to sponsor research of this kind. They would limit all publicly-funded fertility research to sex-typical ways of having children, which they construe as the basis of reproductive rights. This objection has no force against privately-funded research, of course, and in any case not all social expenditures are responses to ‘rights’ properly speaking. Another possible objection raised against gestation by transgender women is that it could alter the social meaning of sexed bodies. This line of argument fails, however, to substantiate a meaningful objection to gestation by transgender women because social meanings of sexed bodies do not remain constant and because the change in this case would not elicit social effects significant enough to justify closing off gestation to transgender women as a class.


You can find the article are here:  http://onlinelibrary.wiley.com/doi/10.1111/bioe.12132/abstract . Or you can contact me.

Thursday, December 11, 2014

This new book may be of interest to people interested in the history of assisted reproductive treatments.  It's the memoir of a physician who played a key role in bringing in vitro fertilization to the United States. 



Tuesday, October 14, 2014

A New Way to Save the Environment: Take Away Government and Insurance Support for Fertility Medicine for Lesbians and Gay Men



In a summer 2014 article in the Journal of Medical Ethics, Cristina Richie proposes to limit human population growth by putting an obstacle in the way of population increase. Richie proposes that governments withdraw all financial subsidy for assisted reproductive treatments for fertile people and that insurers do the same.  That money could only go to people with diseases and disorders that stand in the way of their having babies.

Richie's reasoning is that financial support for fertile people will slow down population growth, but those people can – if they really want to – have children anyway. They can just turn to old-fashioned intercourse, and that doesn’t demand much by way of environmental resources now, does it? 

Richie’s proposal won’t meaningfully slow the demand on environmental resources or contain the problem of carbon emissions because the number of people born through the assistance of fertility medicine is an almost meaningless fraction of the number of new people coming along.

Richie's proposal also has a differential effect on lesbians and gay men, and it is a prejudicial effect.

Same-sex couples must always reach outside their relationship for help in having children. But Richie wants to turn off any financial assistance they might get from the government or insurers for clinical help. Her reasoning is that lesbians and gay men are after all fertile. They’re not infertile like, say, people who have blocked fallopian tubes or who have low sperm production.  There is nothing wrong with their bodies that way (usually). But -- too bad! -- they're fertile, so they are on their own when it comes to paying for clinical help in having children.

Never mind that lesbians and gay men pay the taxes which support fertility medicine for others. Never mind that lesbians and gay men also create profitability for their employers, the employers that Richie hopes will exclude them from the health insurance they provide.

People used to argue that lesbians and gay men shouldn’t have children because their sexuality and relationships are bad for children. Now, Richie wants to put up obstacle in the way of lesbians and gay men having children for a whole new reason: saving the environment!  

I suppose it’s too much to hope that she retracts the article.

Monday, October 13, 2014

What Would Virtue Ethics Mean for Choosing the Traits of Children?



Ryan Tonkens – a lecturer at Monash University – welcomes serious discussion about homosexuality in bioethics. I will summarize here what he has to say about my book Ethics, Sexual Orientation, and Choices about Children. (Those interested in the full review may consult Ethics 2014, vol. 124, no. 2: 431-435.) Tonkens takes a few swipes at some of the particulars of my analysis, but – most importantly – he thinks my approach is unfounded where it is not significantly incomplete, and that there is a better prospect for exploring the ethical questions I raise.

[Murphy Reply 1:  I appreciate the effort Tonkens put into his nearly 2,500-word review, which with a little more work could have been and probably should have been a full-length article rather than a book review.  Even so, I think the praise he offers sits badly alongside the critique he offers. In other words, the criticism he offers is far more damaging to my view than he lets on. Fortunately, that criticism does not succeed in any meaningful way.]

First, as a matter of the book’s structure, Tonkens thinks I give away my ending early on, namely that “parents should generally have the right to use safe and effective prenatal interventions to influence the sexual orientation of their children.” He says I nevertheless offer “a well-rounded discussion of the main philosophical and ethical issues in this area, grounded in a “realistic understanding of what we do and can know about the genetic, biological, evolutionary, and cultural underpinnings of human sexual orientation.”

[Murphy Reply 2:  Again, I appreciate the praise, but as I plainly say, the book is is an analytic history of a debate. I mention this because that framework defines what will be in the book and what will not be in the book. I mention this because Tonkens wrongly expects more from the book than its focus allows.]

Despite the praise, Tonkens does not like some of the things I do and  – worse  – some of the things I don’t do. He finds it interesting that I connect Joel Feinberg’s views about a child’s right to an open future to the idea of controlling the sexual orientation of children interesting. But “for Murphy, sexual autonomy is the right under which its possessor would be protected from undue influence on his or her sexual orientation – among other things -- although he does not take the time to flesh out this concept in any real detail.” Moreover, Tonkens finds that this approach does not square with my view that the law should not intervene if parents decide they wish to influence the sexual orientation of their children.

[Murphy Reply 3: My engagement with Feinberg is to show that choosing one sexual orientation over another – heterosexual or homosexual – does not undermine a child’s sexual autonomy. I don’t know what more Tonkens could want. I offer in fact more fleshing out of the idea of future autonomy as a regulatory ideal than Feinberg himself did. I think it’s a novel contribution to the literature to point out that a homosexual orientation affords someone as much autonomy as a heterosexual orientation, as against being an orientation that is some kind of developmental maladaptation, some kind of compulsion, some kind of emotional immaturity. I also show that a sexual orientation – insofar as chosen – does not undercut sexual autonomy. As for the role of the law, there are lots of things that are morally dumb, and the law takes no responsibility for their correction. If people want to believe that a straight child is the only valuable child, well, go ahead and let them use the prenatal interventions they want:  Doing so will not undercut anyone’s sexual autonomy, so what more does anyone want from the law?]

Tonkens doesn’t like either the fact that I more or less take for granted the United States as my context, and other places where gay men and lesbians can live without too much trouble these days.  In this context, he quotes me as saying that “the wish or hope for a homosexual child is no longer a betrayal in itself of a child’s prospects for happiness.” I actually know some people who – if given the chance – would have tried to have gay and lesbian children if they could. In the United States, Canada, France, Etc., this choice seems to me to carry no ill effects. But what about the Evil Rest Of The World? Tonkens thinks that if someone in Nigeria were to want to have a gay or lesbian child, that very motive would amount to a betrayal of the child’s interests. So, don’t I show myself to be culturally bound?  Worse, he muses, wouldn’t countries like Nigeria want to develop technologies that would help them select against gay and lesbian children?

[Murphy Reply 4: Would it be a betrayal of a child’s interests if parents in a deeply homophobic country took steps to ensure a homosexual orientation in that child? It seems to me that we need to separate out the motive and the effect here. Unless the motive is deeply twisted – to have gay or lesbian children in order to see them suffer at the hands of homophobic society – then the parents’ motive need not be morally suspect. They might want, for example, to have a gay or lesbian child in order to help combat society’s prejudices. Any such parents are likely to cloak their children in some measure of extra psychological protection to help ward off the dire effects of their homophobic culture. So, I’m not persuaded that any parent having a gay or lesbian child in a bad place for homosexual people generally must necessarily betray that child’s interests. As for the need for deeply homophobic countries to develop technologies to help select against gay and lesbian children: Who needs them? Those countries pretty much have everything they need in their campaign against gay and lesbian people: enforced social invisibility, legal prohibitions, deep-seated cultural taboos. Would they really spend the time and money on an effort likely to fail? I wrote about this extensively in my book Gay Science: The Ethics of Sexual Orientation Research, but people deploy this this objection as if it were a moral trump card. It’s not.]

Tonkens is exercised with my tongue-in-cheek reductio of the sexual autonomy argument. If promoting the sexual autonomy ought to be parents’ goal for their children, should they not try to have bisexual children? (Woody Allen probably said it better when he suggested that bisexuality doubles the chances of a date on Saturday night.) Tonkens sees in the issue only a lost opportunity, since he says I fail to identify the upper or lower limits of what sexual autonomy should be for children. Where does sexual interest in trees and dead bodies (his examples) fit in, he wants to know. And what about asexuality? Tonkens finds the lack of thresholds here to be a deficit of my analysis.

He thinks, moreover, that “this sort of worry” – about lack of boundaries – “can be directed equally toward Murphy’s ultimate conclusion, i.e., that parents have the right to use safe and effective prenatal technology to control the sexual orientation of their offspring.” What criteria am I invoking, he wants to know, that would set limits for parents as they took steps to select for asexuality in their children, or – again – sexual interest in trees? 

[Murphy Reply 5:  Suppose I argue that it is safe for cars to travel on highways at 65 miles per hour. Do I need to also show what the upper limit of safe speed might be or the lower limit of safe speed? Tonkens loses sight, I think, of what I’m trying to do:  describe the history of a debate and analyze the claims in that debate. Getting to a philosophically defensible conclusion about the ethics of intervention in homosexual and heterosexual orientations does not require a full theory of the extent to which parents may influence the sexual interests of children in their entirety. That seems to be what Tonkens is looking for in my book. It’s not there, because that’s not what I need to resolve in order to make sense of the debate over one particular topic. And sexual interest in trees? Well, that’s a new one for me, but I wonder if I’ll ever be able to look at a tall brooding oak tree or lithe and limber willow tree in the same way again.]

Tonkens credits me with an “interesting claim” that people who do not want homosexual children and who would be bad parents of homosexual children probably should not have them, in order to protect the welfare of children. He says “This conclusion seems plausible, especially if we focus exclusively on rights and harms/benefits as our normative starting point—something Murphy does in this book.”  But Tonkens gives with the left hand here what he will take away with the right.  He says that I “offer no justification to support this choice of normative framework over others.”

This move sets the stage for Tonkens to gesture toward some other starting point which would somehow provide a convincing rationale that parents who do not want gay and lesbian children should go ahead and have them and that their doing so would not be harmful for those children. That other starting point is “contemporary virtue or character ethics.” Tonkens suggests that this perspective would require parents to abstain from prenatal interventions to control the sexual orientation of their children.  The general idea can be summed up this way: What person with well-developed values, what person with well-developed character would even care about the sexual orientation of their children? What’s more, these upstanding parents would shy away from any interventions that could carry risks for their children, and since techniques of prenatal intervention would presumably carry some risk, wouldn’t they be imposing risk by using them when they could avoid those risks entirely by not using them? As Tonkens sees things, one of the shortcomings of my analysis is that I do not “mention any such virtue-based considerations, and thus we are left to speculate about what his reaction to them might be.”

[Murphy Reply 6: I don’t think Tonkens faces up to the full effects of his invocation of virtue ethics. He seems to be suggesting that virtue ethics should be a framework by which to analyze these matters and that it opens the door for an entirely different conclusion than the one I offer. First, let me say that I did not take up virtue ethics because no one has to date offered any such analysis of the issue and – forgive me for repeating this for the umpteenth time  – my book is the history of an actual debate, not the history of an encounter with all possible views on the topic. If Tonkens wants to wade into this territory under the banner of virtue ethics, he is welcome to do so. But it is just carping to complain that I did not review a kind of analysis that has not yet been deployed.  In any case, I do not believe that any virtue-based approach would alter the conclusions I offer. What does virtue ethics want? Something like this: decisions guided by their conformity to certain virtues or expressive of certain virtues so far as possible. Under such an approach, is it possible to say that no parent should ever take steps to influence the sexual orientation of children? This seems to me an impossible position to defend. Let’s remember our parents in Nigeria. Would they not be acting in conformity with various virtues if they took steps to ensure that their children would be heterosexual? After all, Tonkens himself has said that taking steps to have a homosexual child in that country would be a betrayal of their interests. I do not see that virtue ethics has anything to add here. Really, not anything capable of altering a strong presumption in favor of parental choice, both as a matter of ethics and law.]

Despite setting out a framework he thinks is positioned to demolish my conclusions, Tonkens concludes his quite-long review with the generous praise that “For its engagement with important, philosophically rich issues in a well-rounded, scholarly manner, this book is a positive addition to the debates that Murphy surveys therein.”

Tuesday, October 7, 2014

Uterus Transplants: Are They in the Cards for Transgender Women?

Some commentators want the state to support infertility research only in bioconservative ways.These commentators think the state should spend only to help people have children in their given sex, namely as people born men or born women.

Where does this leave transgender women and men?

By way of partial answer, I have written an analysis that opens the door to state support for research to help transgender women gestate children.

That article will be coming out shortly in the academic journal, Bioethics. 

Ahead of that publication, here's a short summary of how I make the case that the state could have some responsibility for helping transgender women have children.  Along the way, I ask a fairly important question:  does the state have to presume that you are one sex and that you will only remain one sex for the entirety of your life?  It turns out that answer to this question is not an obvious 'yes.'


Assisted Gestation and Transgender Women
Timothy F. Murphy
Abstract. Developments in uterus transplantation put the prospects for assisted gestation within meaningful range of clinical success for women with uterine infertility who want to gestate children. As this kind of transplantation becomes increasingly safe and effective for those women, would there be any morally significant reason why men or transgender women should not be eligible for the same opportunity for gestation? Getting to the point of safe and effective uterus transplantation for those parties would require a focused line of research, over and above the study of uterus transplantation for non-transgender women. Some commentators object to the idea that the state has any duty to sponsor research of this kind. They would limit all publicly-funded fertility research to sex-typical ways of having children, which they construe as the basis of reproductive rights. This objection has no force against privately-funded research, of course, and in any case not all social expenditures are responses to ‘rights’ properly speaking. Another possible objection raised against gestation by transgender women is that it could alter the social meaning of sexed bodies. This line of argument fails, however, to substantiate a meaningful objection to gestation by transgender women because social meanings of sexed bodies do not remain constant and because the change in this case would not elicit social effects significant enough to justify closing off gestation to transgender women as a class. (Forthcoming in Bioethics.)

Amazing: Child Gestated with Transplanted Uterus

Earlier this year, a clinical team at Gothenberg University in Sweden carried out a clutch of uterus transplants, into women with 'absolute uterine factor infertility.' That means they were either born without a uterus or had some disease that required the removal of the uterus.

Many -- but not all -- women want to have the experience of gestating their children, so there have been various efforts over the past couple years to perfect uterus transplants for these women.

The first effort involved a uterus taken from a dead donor, but the transplants in Sweden involved living donors.

Amazing to report:  this team has achieved the first live birth of a child, gestated in a transplanted uterus.  As the clinical team reported, they have completely done away with the diagnostic category:  "absolute uterine factor infertility" because that condition -- not having a uterus -- is not absolute anymore. 

For some details, see:  http://www.bbc.com/news/health-29485996

(The scientific journal article is:  M.Mats Brännström, L. Johannesson, H. Bokström, et al., The Lancet, epublished Oct 6.  It's unfortunately behind a paywall, unless your library has access.)


Sunday, April 27, 2014

Uterus Transplants for Transgender Women?


Clinical researchers in Sweden have been busy with a project to transplant uteruses into women who cannot gestate children of their own.  They carried out 9 such transplants in early 2014.
 
 http://www.theguardian.com/society/2014/jan/13/womb-transplants-success-swedish-project

Apparently, some of these transplants have failed, but researchers have carried out embryo transfers with some of the women, in order to secure a pregnancy for them.

If uterus transplants are successful in women, would this kind of assisted gestation work for others, for men or transgender women? I am working on an analysis of this question, which is not ready for public presentation yet, but if anyone wants to contact me about it, feel free.

In the main, some of the key questions are these:  If uterus transplant proves safe and effective for women, would there be any morally significant reason why men or transgender women should not be eligible for the same opportunity for gestation?

Getting to that point of safe and effective uterus transplants for those parties would require a focused line of research, over and above the study of uterus transplantation for non-transgendered women.

Now, some commentators object to the idea that the state has any duty to sponsor research of this kind. They would limit all publicly-funded fertility research to sex-typical ways of having children, which they construe as the basis of reproductive rights.

This objection has no force at all against privately-funded research. If private researchers want to pay for this research, they get to decide how to spend their money.

In any case not all social expenditures are responses to ‘rights’ properly speaking. The state spends lots of your money doing things that you don't have a 'right' to, such as beautification projects. Do you really have a right to a beautiful park system?  The state must spend its money wisely, of course, but if someone makes the case that it would raise the overall welfare of transgender women as a class to enable them to gestate, well, it would hard to say that the state should never spend its money that way.