In my work, I explore the impact of family norms on the development and use of reproductive technologies. I am also interested in the normative challenges that technologies raise for the ways in which norms about reproduction and the family are conceptualised. For example, in several papers I discuss questions of access to reproductive technologies by older women (Cutas 2007, Cutas & Smajdor 2015, Cutas, Smajdor and Hens 2017). In two papers, I challenge the view that children ought to have no more (Cutas 2011) and no less (Cutas and Smajdor 2017) than two parents. In a forthcoming paper, I problematize legal initiatives to connect fatherhood status to genetic parentage when the fatherhood presumption is questioned (Cutas and Smajdor 2020).
Whether the relation between two or more individuals is called a ‘family’ depends on normative assumptions about the kinds of relationships that people should be in, and has implications on the way in which their claims are met, socially and institutionally. Whether one’s desire to become a parent deserves medical attention depends on normative assumptions about the kinds of environments in which children should be born: children should be conceived naturally and born to their parents who are young, heterosexual, and married to each other. This is not only the ideal relationship between parents, but also between adult romantic or sexual partners (Cutas 2016). One may ‘experiment’ in one’s youth with other forms of intimacy, but monogamous romantic relationships are what one should aim for in adulthood. Romance and sexual intimacy are at the core of our closest personal relationships: everything else is secondary and may be invisible in the eyes of the law (Cutas and Chan 2012). According to Article 16 of the Universal Declaration of Human Rights, “the family is the natural and fundamental group unit of society and is entitled to protection by society and the State”. This holds even when such protection may be detrimental to the members of the family (Cutas and Smajdor 2017). Against this background, normative choices are presented as conceptual definitions, and the outliers are left to make their case and gain legitimacy – and permission – from their standing point as other than the default: other than the fundamental group unit of society.
This framework is at the basis of much of the current status quo in the regulation of close personal relationships, human reproduction, and family life. While marriage and legal parenthood include predefined bundles of rights and duties, other kinds of relationships do not. Insofar as regulations have been changed to accommodate other family forms, this has been done in an incremental manner with the nuclear family still the default. For example, infertility tends to be defined as non-conception in the heterosexual couple. ‘Clinical infertility’, according to the World Health Organisation, is ‘a disease’ that manifests itself in a couple’s failure to produce a child after more than one year of unprotected sexual intercourse. This definition, and variations of it, are part and parcel of the regulation of fertility treatments, alongside other considerations such as marriage or long-term cohabitation between partners.
A single woman or a same-sex couple cannot produce children in this way. Unlike the clinical infertility of the heterosexual couple, the incapacity of these other individuals or couples is seen as circumstantial: its causes are social, not clinical. People could always pair up with individuals with whom they are reproductively compatible (i.e. heterosexual) and then if after a certain amount of time they have not produced a child, they may aspire to the diagnosis of clinical infertility. The single woman is not infertile just because she may, for example, lack fallopian tubes. When she has a male partner and a pathology that prevents reproduction is known, the waiting time may not be required: so they may be diagnosed, as a couple (though they may still have to have lived together and/or been married to each other for a certain amount of time in order to gain access to treatment). A woman who does not suffer from any pathology preventing her from reproducing may be eligible for treatment. She will be on the receiving end of much of the procedures, even if it is established that it is her male partner who suffers from a pathology, or when no pathology is found at all. Her incapacity to reproduce with her current partner is not seen as circumstantial and she has a legitimate medical need for treatment even if she could reproduce with someone else. Where this framework is in place, the single woman or the same-sex couple are not seen as having such a need, because they are not infertile, even if they may not be able to reproduce without medical assistance, whatever they did.
The aim of fertility treatments is not to restore a function: it is not to make the couple able to conceive and have a child via sexual intercourse. It is, instead, to bypass that capacity and provide the couple with a child. What is treated is the desire to have a child: if not for this desire, there would be no need for treatment. Yet it is not the intensity of the desire, or of the suffering of its frustration, that determine access to or priority for fertility treatments. The single woman or the same-sex couple may well be suffering more: at least the couple have each other; at least the heterosexual couple have a chance to reproduce together, or to qualify for adoption where same-sex couples are barred. Such are however not relevant considerations in legislatures where only heterosexual couples’ suffering deserves medical attention or financial support. Moreover, it tends to be taken for granted that this desire is not to have just any child. It is the desire for a child who is obtained from the reproductive material of both members of the couple; failing that, a child obtained with reproductive material from at least one member of the couple; and only failing that, a child who is not genetically related to the couple. Therefore, from the perspective of this definition, fertility treatments treat the suffering caused by the incapacity to fulfil the desire to become the parents of (preferably) a specific kind of child, and only of certain sufferers, depending on their relationship status and other non-medical considerations (Smajdor and Cutas 2015).
The more people’s lives have diverged from the ideal of the nuclear family, the more scrutiny they have faced. Although significant progress has been made, this model is still the norm. Separating its elements – or aiming to reorganise its parts – has led to significant conundrums: if a child’s social parent is not the same as her genetic parent, and both (or all) claim legal parenthood, whose claim should prevail? How – if at all – should genetic connections with people who are not members of one’s legally sanctioned family be recognised? Why can a mother and daughter not share legal parenthood of a child they are raising together? Socio-cultural changes as well as technological innovations – including, not least, the capacity to detect mismatches between genetic and social parenthood – rip at the seams of the nuclear family model. This makes more evident the need to reflect on the justification of norms in close personal relationships, reproduction and the family and, perhaps, to refine and revise them.
Daniela Cutas is Senior Lecturer in Practical Philosophy at Umeå University and the University of Gotheburg.