Goold and Savulescu argue that all women should have access to FP technologies on the basis of equal concern and respect for women. They maintain that provided women are fully informed and prepared to deal with the potential “failure of their insurance policy”, women should not be restricted from freezing their eggs because they are outside the disease-related context. In their consideration of the differences in the timing and the cause of infertility, Goold and Savulescu argue that ultimately neither difference is morally relevant.
The first difference Goold and Savulescu consider is the timing of infertility. In the disease-related cases and the age-related cases, the time of anticipated infertility is different. In general, women who cryopreserve for disease-related reasons can expect to become infertile much sooner than women who cryopreserve for age-related reasons. Women who have cancer and use FP for disease-related reasons often experience decreased fertility or infertility at the onset of cancer treatments, such as chemotherapy and radiation. In contrast, women who cryopreserve their reproductive material for age- related reasons are generally less certain about when they will experience infertility. On average, fertility begins to decline around the age of 35 years, but menopause occurs on average at age 51 (Best Start, 2007). So, for example, a woman who cryopreserves her oocytes in her twenties might have about a decade of optimal fertility and increasingly reduced fertility until menopause. If she enters menopause around age 50, she will have had up to 30 years of fertility after the time of stage 1 FP. Goold and Savulescu
understand the difference in timing of infertility as the temporal difference in the occurrence of menopause.
The difference in timing, according to Goold and Savulescu, is not morally relevant. To show this, they invoke the principle of temporal neutrality (Goold & Savulescu, 2009, 43). The principle of temporal neutrality states that the time at which benefits and harms happen in one’s life has no normative significance in itself (Brink, 2010, p. 1). As such, this principle demands that all times in a person’s life be given equal concern with respect to the occurrence of a particular harm or benefit. In other words, all things considered, a particular harm that occurs today is not morally more important or more valuable than a similar harm that happens next year. As such, the timing of a harm (or benefit) is independent of any analysis of an agent’s overall well-being. With respect to FP, the harm of infertility is no worse for a woman if it happens sooner (as in the disease- related context) or later (as in the age-related context). So, the time at which a woman becomes infertile bears no moral weight; it is not relevant to the moral permissibility of her choice in favour of FP because the harm she incurs with infertility is similar. In other words, a woman’s choice to use FP to guard against infertility that will occur in two months’ time is no different morally speaking, than a woman’s choice to use FP in order to guard against infertility that will occur in ten years’ time.
The second difference between disease-related and age-related FP that Goold and Savulescu identify as a possible morally relevant difference is the cause of infertility for women in each group. In the context of disease-related infertility, infertility is often caused by therapeutic interventions by the physician.51 This type of infertility is iatrogenic. In contrast, infertility in the age-related context, is non-iatrogenic (or self- generated). Goold and Savulescu identify menopause as the cause of age-related
infertility. Insofar as infertility in the disease-context is caused by medical interventions, one might be inclined to think that it is morally different from infertility that occurs
51
Some women do conceive naturally following a fertility-threatening cancer treatment.
‘naturally’. However, Goold and Savulescu argue that in types of FP the cause of infertility is not morally relevant, because many infertile women who desire a
biologically-related child will still experience the psychological hardships and losses that are associated with infertility, regardless of the cause of infertility (Goold & Savulescu, 2009, p. 52).
According to Goold and Savulescu, the timing and cause of infertility seem to bear little, if any moral relevance to the permissibility of FP choices. Their analyses draw attention to the harms and hardships incurred by women who become infertile, regardless of whether the harm of infertility occurs sooner or later, because of medical interventions or because of menopause. In both the disease-related and age-related cases, the harms associated with (anticipated) infertility can be alleviated by allowing women access to FP technologies.
In one respect, Goold and Savulescu are correct to highlight the comparable suffering incurred by infertile women, regardless of how or when this infertility incurs. For women who wish to bear a genetically-related child, the inability to fulfil this desire can cause a tremendous amount of suffering and pain. In chapter two I discuss some of the harms associated with infertility. Critics of age-related FP might agree that any woman who is infertile suffers some harm, but the suffering associated with infertility is only one part of the moral picture.
I suggest that many critics of age-related FP understand the moral relevance of the differences in the timing and cause of infertility in a way that is different from what Goold and Savulescu describe. Critics of age-related FP believe that the difference in the timing and cause of infertility in each FP context represents a difference in the degree of reproductive control and choice that are afforded to women for each FP context. As such, Goold and Savulescu’s arguments about the moral differences between disease-related and age-related infertility fail to show that there is no moral difference between age- related and disease-related FP. In the next section, I explain in more detail, the objections to age-related FP that are grounded on differences in choice and control.