Published online by Cambridge University Press: 31 March 2017
Certain changes in the way that states classify people by sex as well as certain reproductive innovations undercut the rationale for state identification of people as male or female in signifying gendered parental relationships to children. At present, people known to the state as men may be genetic mothers to their children; people known to the state as women may be genetic fathers to their children. Synthetic gametes would make it possible for transgender men to be genetically related to children as fathers and transgender women to be genetically related to children as mothers, even if they have otherwise relied on naturally-occurring gametes to be genetic mothers and genetic fathers of children respectively. Synthetic gametes would presumably make it possible for any person to be the genetic father or genetic mother of children, even in a mix-and-match way. Other reproductive innovations will also undercut existing expectations of gendered parental identity. Uterus transplants would uncouple the maternal function of gestation from women, allowing men to share in maternity that way. Extracorporeal gestation ((ExCG)—gestation outside anyone’s body—would also undercut the until-now absolute connection between female sex and maternity. In kind, effects such as these—undoing conventionally gendered parenthood—undercut the state’s interest in knowing whether parents are male or female in relation to a given child, as against knowing simply whether someone stands in a parental relationship to that child, as a matter of rights and duties.
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10. This is not to say that the standards in these emerging approaches to civic sex are any less normative than the standards that invoked body traits; they are simply normative in a different way in regard to determinations of who qualifies as male and female and who does not.
14. The World Professional Association for Transgender Health advises clinicians to counsel people about fertility preservation as a matter of informed consent. Coleman, E, Bokting, W, Botzer, M, Cohen–Kettenis, P, DeCuypere, G, Feldman, J, et al. Standards of care for the health of transsexual, transgender, and gender non-conforming people, Version 7. International Journal of Transgenderism 2011;13:165–232.CrossRefGoogle Scholar This organization declares the right of transgender people to have access to any fertility treatment that is available to others. See also: Murphy TF. The ethics of fertility preservation in transgender body modifications. Journal of Bioethical Inquiry 2012;9:311–6; and Wallace SA, Blough KL, Kondapalli LA. Fertility preservation in the transgender patient: expanding oncofertility care beyond cancer. Gynecological Endocrinology 2014;30:868–71. See also Wahlert L, Fiester A. The questions we shouldn’t ask. Cambridge Quarterly of Healthcare Ethics 2012;21:282–4. Murphy TF. Commentary: Crossing cultural divides: transgender people who want to have children. Cambridge Quarterly of Healthcare Ethics 2012;21:284–6.
17. Almost reflexively, reports of advances in synthetic gametes are met with discussions of the implications for same-sex couples. That was, for example, the reaction to Irie N, Weinberger L, Tang WWC, Kobayashi T, Viukov S, Manor YS, et al. SOX17 is a critical specifier of human primordial germ cell fate. Cell 2015;160:253–68.
18. Surprisingly, this approach would quiet certain (but not all) objections to same-sex couples as parents, such as the objection raised by Daniel Callahan against gamete donation in general and anonymous donation in particular. Callahan sees gamete donation—without any subsequent parental role for the donor—as an abdication of responsibility for one’s children. With the advent of synthetic gametes, no third-party gametes would be required for same-sex couples, no other parties would have to help them have children, and no other parties would be relinquishing parental responsibility. Callahan D. In Search of the Good: A Life in Bioethics. Cambridge: The MIT Press; 2012. For further discussion, see Murphy TF. The meaning of synthetic gametes for gay and lesbian people and bioethics too. Journal of Medical Ethics 2014;40:762–5.
19. For purposes of this analysis, I accept this benefit at face value while also noting that many people happily raise children who are not genetically related to them. For example, Thomas Murray has said: “Genetic parenthood is incidental to parent–child mutuality.” (See Murray TH. Three meanings of parenthood. In: Rothstein MA, Murray TH, Kaebnick GE, Anderlik Majumder M, eds. Genetic Ties and the Family: The Impact of Paternity Testing on Parents and Children. Baltimore: Johns Hopkins University Press; 2005:18–34.) I am saying only that whatever benefit attaches to having children with shared genetics could be available to same-sex couples.
20. Cutas D, Smajdor A. “I am your mother and your father!” In vitro derived gametes and the ethics of solo reproduction. Health Care Analysis 2016 [Epub ahead of print]. DOI: 10.1007/s10728-016-0321-7.
22. Some critics worry that interest in gestation on the part of transgender women may be induced by objectionable social conceptualizations of women, conceptualizations that condition women’s value on and only in relation to childbearing. Even if the desire for a uterus transplant is somehow an artifact of social pressure to bear children, it is unclear as a matter of access and equity why only transgender women should be protected from pursuing transplantation to enable gestation, in the name of protecting the integrity of their choices. See Fulfer K, Petropanagos A. Does a womb make you a woman? International Journal of Feminist Bioethics Blog, July 9, 2014; available at http://www.ijfab.org/blog/does-a-womb-make-you-a-woman/ (Last accessed 20 July 2016). See also Murphy TF. The moral effects of uterus transplantation. International Journal of Feminist Bioethics Blog, July 27, 2014; available at http://www.ijfab.org/blog/does-a-womb-make-you-a-woman/ (Last accessed 20 July 2016).
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24. Chavatte–Palmer P, Lévy R, Boileau P. Une reproduction sans utérus? État des lieux de l’ectogenèse [Reproduction without a uterus? State of the art of ectogenesis]. Gynécologie Obstétrique & Fertilité 2012;40:695–7.
25. See, for example, the raft of objections raised by Overall, C. Human Reproduction: Principles, Policies, Practices. Toronto: Oxford University Press; 1993.Google Scholar
27. Some commentators object to the idea that marriage ought to be valued by same-sex couples and all other couples too because they believe it to be a morally flaws social relationship, It is, however, hard to deny that marriage offers positional advantages to same-sex couples relative to advantages available to unmarried same-sex couples.
28. The state is, of course, still entitled to identify other features of the people in question, such as their age and their current marital status, but none of this identification requires knowing the sex of the parties in question.
29. Obergefell v. Hodges. 576 U.S. (2015).
30. American Psychiatric Association. Gender dysphoria. In: Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC: American Psychiatric Association; 2013.
31. I will also mention in passing that it is not clear that two parents, one male and one female, are the only people that children need as parents. The state might consider whether more than one parent is desirable, relative to the way in which a child is brought to exist and/or relative to the needs of the child afterward. On the prospect of more than two parents see Cutas D. On tri-parenting: Is having three committed parents better than having only two? Journal of Medical Ethics 2011;37:735–8.
32. To assign genetic maternity and paternity under these circumstances would be to do so entirely on the basis of the chromosomes of the gametes involved, rather than in relation to the chromosomes of the persons offering the gametes. No genetic woman would stand behind a synthetic ovum, and no genetic man would stand behind a synthetic sperm.