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Book Review: Relatedness in Assisted Reproduction - Families, Origins and Identities

9 February 2015
Appeared in BioNews 789

Relatedness in Assisted Reproduction: Families, Origins and Identities

Edited by Fatemeh Ebtehaj, Dr Tabitha Freeman, Susanna Graham and Professor Martin Richards

Published by Cambridge University Press

ISBN-10: 1107038286, ISBN-13: 978-1107038288

Buy this book from Amazon UK

This collection of interdisciplinary perspectives and empirical observations on the meanings that are attached to a concept of 'relatedness' in fertility treatment is an important read for anyone involved in assisted conception.

While the word 'relatedness' is thought to be commonly understood, its meaning in the fertility context is multi-varied, oscillating in salience as connections between children, parents and others are both made and unmade through the use of donor gametes. By identifying how relatedness is shaped by patients' experiences and also the wider cultural, legal and policy landscape, this text as a whole challenges taken-for-granted assumptions, presenting fresh considerations for clinical staff, policymakers, lawyers and all those involved in fertility treatments generally and in the creation of 'alternative' families. It highlights tensions, inconsistencies and paradoxes in how people navigate the fertility process.

Introducing the book, Tabitha Freeman identifies how the expressed relevance of biological connections to legal and cultural definitions of parenthood evidences how 'naturalised' notions of kin relations remain prevalent. This is despite the observation that changing family structures have fragmented social and biological kinship to reveal how these concepts are socially constructed, rather than factually determined. This tension is a central theme in the text, with contributing chapters demonstrating how this duality (at the very least) makes for complex and fluid definitions of what relatedness mean to patients and their families.

The breadth from which relatedness is approached in this text is testament to the complexity of the investigation. It is surprising to read just how much law and policy remains fundamentally unchallenged, and based on so many assumptions that, in reality, may not bear out. There is much discussion of the importance of genetic connection in the law, but this assumption is challenged by how genetic relatedness is understood by patients and their families.

For example, Martin Richards traces the socio-legal regulation of kin connections with donor-conceived children and the 'genetic connection' view of these relationships, concluding that the notion has taken on a new meaning of its own. He identifies how the notion of 'genetic connection' encourages a biologically determined view of parenting, but that the attitudes of donors, recipients and families may be quite different.

Elsewhere in the text, Julie McCandless and Sally Sheldon question the significance of genetic links in the legal determination of parenthood, showing that as they remain highly relevant to establishing parental status, they are also 'gendered' in that they have tended to focus on fatherhood in the courts.

This critical approach to conventional understandings is also taken to debates around the importance of the genetic connection to children. John Appleby and Anja Karnein argue that the perceived harmful consequences for children with no genetic ties to their parents are more likely to be due to social conventions not ready to accommodate emerging family forms, questioning that it should not be 'wrong' to raise a genetically unrelated child just because it would be easier to grow up as part of a traditional nuclear family.

Central to this critique is the finding that many of the meanings attached to donor conception resist categorisation or static rationalisation. They are instead fluid, inconsistent and very situational. For example, Jeanette Edwards highlights how biological facts are socially activated in kin or 'dekinning' processes, showing that kinship is an 'active, reflexive and intentional process' for many fertility patients and their families. The donor thus can both be irrevocably connected and also 'excised', perhaps even simultaneously.

In another chapter, Nicky Hudson and Lorraine Culley assess the importance of race and ethnicity among minority communities, concluding that despite being a social and discursive construct, an idea of race and biological qualities persist in lay understandings of ethnicity and can play out when concerns of physical similarly become associated with fitting in the community and avoiding stigmatisation.

These observations may have important practical consequences for those involved in donor conception. For example, Andrea Braverman and Lucy Frith explore how professionals present information about disclosure (of donor origins to the future child) in consultations with parents, observing that assumptions about families and relatedness underpin professional discourse, and also how clinical practice can shape decisions made available to children.

These are just examples of the scope of the text, with further chapters on donor perspectives (Almeling), surrogacy arrangements (Jadva and Imrie), single women (Graham), gay fathers (Smietana et al), children (Blake et al), contacting donors (Freeman et al) and the wider family (Nordqvist and Smart). International perspectives are also given from North America (Cahn) and Europe (Provoost and Pennings). What unites them all, perhaps, is an emphasis on empirical observations of families' experiences of assisted conception that challenges conventional thinking, traditional family models and even the very language and terminology used to describe to such relationships.

The volume contributes at least two significant considerations for law and policymaking in this area. First is the observational evidence to challenge traditionalist paradigms and assumptions that underpin legal rules and policy making. It is vitally important that in a developing area of law such as this, as cases are deliberated by judges and policy discussions take place, that the experiences and meanings for those who are beneficiaries of contemporary regulation – the users, not service providers - are heard. And - crucially - it is the experiences of the everyday person, and not some highly rationalised and somewhat paternalistic interpretation of people's experiences, that should help inform (not drive) legal development.

Second is the emphasis of a lack of uniformity or generality, and the importance of personal preference and subjective experience. Complexity presents a difficult regulatory challenge, but it shows how law based on or promotes form and substance, rather than fluidity, may be wrong footed and fails to grant proper recognition to reflexive and relational decision-making processes, which can be important and meaningful to the individual and also the wider family or community. Rather than fixed determinations of interests, the assisted conception process should warrant a non-judgmental respect of the exercise of agency and decision-making (both individualistic and relational).

From a normative perspective, perhaps what unites a number of these perspectives in this text is that some version of autonomy is at play. The observations can help inform a mode of governance that respects personal and familial decision-making on the wider level, as well as the idiosyncratic interests in assisted conception.

Buy Relatedness in Assisted Reproduction: Families, Origins and Identities from Amazon UK.

1 September 2015 - by Dr Berenice Golding 
Drawing upon professional and personal perspectives, this book renders visible some of the hidden issues that prevail when donor conception is used to build a family...
26 May 2015 - by Antony Starza-Allen 
Susan Golombok's 'Modern Families: Parents and Children in New Family Forms' challenges the assumption that the traditional nuclear family is the best environment in which to raise children...
14 July 2014 - by James Brooks 
How has the genetics boom impacted donor-conceived people, their families and the choices they make? Does genetics really provide vital information which people need to take on board to make informed decisions? Has family law moved with the times to take new reproductive technologies and arrangements into account?...
2 June 2014 - by Petra Nordqvist 
How do genes and genetic relationships actually matter in the messy and complex world of everyday life? The event 'Do genes matter? Donor conception and family life' discussed genetic connections and family life from the legal, sociological and scientific points of view...
28 May 2014 - by Cait McDonagh 
Since 1991, more than 35,000 children have been born in the UK as a result of donor conception, and our knowledge of genetics has increased substantially during that time. The event 'Do Genes Matter? Families and Donor Conception' set out to ask whether our understanding of family has changed too...
12 May 2014 - by Sarah Norcross 
I don't often put my hand up to review books when they pop through the letterbox. Normally, after the pleasure of opening the parcel and inhaling the scent of fresh book, I quickly put it on someone else's desk...
8 July 2013 - by Antony Starza-Allen 
Families are complicated and no two are the same. It is often said that assisted reproductive technologies (ART) challenge traditional family models. But what has received less attention to date is how these 'new families' navigate a complex thicket of social, legal and policy norms...
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