Bodily Integrity in the Age of Dislocated Human Eggs
In late October of 2012, soon after the American Society for Reproductive Medicine (ASRM) lifted the experimental label from human egg freezing, the good news spread like wildfire (Frappier 2012). Egg freezing is a medical procedure that harvests and removes a female’s mature oocytes (eggs) from her body for rapid freezing and storage for later use. Even though the ASRM report deliberately warned against healthy women freezing their eggs for the sole purpose of delaying childbearing, some saw with egg freezing a world-changing opportunity. This opportunity rested in the idea that the institutional failures that females faced as both laborers and eventual mothers could be relieved by a medical procedure. Bloomberg Businessweek aptly identified the solution and the problem in a 2014 headline, “Freeze Your Eggs, Free Your Career.” For tech giants Facebook and Apple, egg freezing is now a part of professional benefits packages.
The purpose of this article is to explore the entangled, and valuable, arguments happening at the forefront of debates about the ethical merits of this procedure. This article explores the implications of meeting the institutional failures that women experience in labor and maternity, which largely fall in the categories of wages, policy, and distribution, with solutions in the medical, physical, and surgical realm. What is the impact of this procedure on the bodily integrity of the female patients implicated, and to what end we will we see such physical distortion in the name of labor? Justice Cardazo famously promised the right to bodily integrity in the case of Scholoendorff v. The Society of New York Hospital (1914): “Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient’s consent, commits an assault, for which he is liable in damages.” The question here is by what social processes will we put the female body under the surgeon’s knife, remove her fertility and put it in the freezer, and it be considered socially acceptable?
The notion of a disjointed body, or the removal of body pieces, parts, and bits for sale is disturbing. Medical anthropologists and ethicists have long been exploring what makes a body and why we make rules, regulations, and moral codes to protect its integrity. Most agree that in order to understand the fragmentation and commodification of the body, we must inevitably define the body and what it is (Sharp 2000). In order to understand what “the body” is, one must delve into the particularized context of a human being, and its world, to understand how boundaries of the body are invented, shifted, and made to matter.
As it emerged, the medical procedure for egg freezing was marketed to promote female liberation. Campaigns encouraging perfectly healthy women to undergo egg freezing happened almost immediately after Sheryl Sandberg famously published Lean In: Women, Work, and the Will to Lead (2013). The book’s release launched global campaigns that foregrounded conversations about gender and the workplace, critiqued bad policies for working mothers, and initiated public dialogue. Lean In faced critique, notably by Pulitzer Prize-winner Susan Faludi and celebrated author bell hooks. These writers argued that Sandberg’s message was corporate-driven, encouraged self-objectification at the mercy of capitalism, discouraged solidarity among women, and was ignorant to race and intersectionality. The medical technology for egg freezing could not have been timelier.
My earliest impressions of elective human egg freezing were of those that I had seen depicted in the media: “the great equalizer” (Time), “liberating…for professional women,” (The Guardian), and the key to “offering women a chance” (Vogue). The insistence of freedom that came with this new medical technology became a site of important dialogue by and among women. Revelations about women in the corporate world that surrounded the emergence of egg freezing made the procedure one that could be something of a solution: the deeply institutionalized, exclusionary consequences of capitalism could be fixed for an individual, on the individual level of her body. Would this individual-level solution remedy the problems being articulated by working women? Or would it fall prey to the same institutionalized systems that marginalize them? The answers invite nuance. One way to answer these questions is to use bioethical frameworks.
On the individual level lies the most obvious quandary within medical ethics debates: the question of ‘rights,’ and whether or not women should have the ‘right to’ this procedure. A female’s eggs are in her body, and comprise her body. All humans, to some extent, share a common sense about a right over our own body; our bodies and our body parts are not just resources to be allocated according to normal principles of public policy (Wilkinson 2011). The debates of ‘rights’ and ‘should’ offer us insight into the suffering and adversity that created the grounds on which such a gendered procedure could emerge, and be contested.
Other debates bring to light concerns for the safety and efficacy of the procedure, and the dismally poor record of doctors obtaining informed consent from their patients. Concerns for research ethics shed light on disparities between the demographic of research subjects, and the demographic being marketed the procedure. The subjects that established influential data to prove that egg freezing could be successful were “young donors, (whose eggs were) frozen for a relatively short time and used for IVF cycles in patients younger than thirty five years of age” (Linkeviciute 2015). The large majority of women seeking egg freezing procedures are in their late thirties (Nekkebroeck et al. 2010). In fact, the National Summary Report in 2014 by the Society for Assisted Reproductive Technology did not even report the cumulative outcomes per intended egg retrieval for women younger than 35 (SART 2014).
Additionally, studies show that egg freezing is least likely to work for women in the late-thirties age bracket (Pelin Cil et. al 2013). Women who do choose to freeze their eggs in their late thirties for later reimplantation of a fertilized embryo are made vulnerable to a whole host of possible risks associated with advanced maternal age, including gestational diabetes, preeclampsia (Von Wolff et al. 2015), placentation defects (Jackson et al. 2015), etc. This may suggest that the physical distortion of the body is not just in the removal of eggs but in the way the body responds to the procedure, adjusts to its side effects, and how it may heal or suffer.
Most offensively, a study published in 2014 proved that out of 147 clinics that offer elective egg freezing in the United States of America, only 7 present all of the relevant information to their prospective clients, and 119 clinics fail to provide the necessary and sufficient information for informed consent to be present (Avraham et al. 2014). Informed consent is at the heart of modern medical ethics (Wilkinson 2011). So long as the patient of this procedure does not have an informed consent transaction, we cannot do justice to understanding the complexity of the choices she makes with respect to her fertility. This may require a trip back to the drawing board with respect to the information we think should cultivate this consent process, especially for a procedure toeing frontiers in reproductive, elective, and preventative medicine.
Testimonies, narratives, and even quantitative data on the suffering of infertility reveal it to be comparable to the suffering of other serious medical conditions, including cancer, (Domar et. al 1993), principally in the anxiety and depression that accompany. Infertility is frequently compared to cancer, which is ironic because the biomedical research originally developing elective human egg freezing was on behalf of youth cancer patients, who were facing infertility due to cancer treatment. Cancer, in this case, is caught in the “trappings of metaphor,” revealing infertility, as the subject of this metaphor, as a condition which is “ill-omened, abominable, (and) repugnant to the senses (Sontag 1978).
Infertility is widely understood to invoke great pain for those who suffer its reality. Egg freezing therefore purports to heal this ailment of infertility that occurs when women cannot have children due to aging. Campaigns for egg freezing argue that women miss a crucial window in their fertility because they are too busy working or pursuing higher education. Emerging research is revealing that despite campaigns marketing egg freezing as a way to help free time for women to pursue their education and career, women actually seeking the procedure are doing so because they do not yet have a partner (Kyweluk 2017).
These campaigns argue, perhaps rightfully so, that the “biological clock” makes women a poor fit for employment institutions that rely on a system of “working your way up.” Women are perhaps a poor fit because these employment institutions were not designed around their inclusion. Removing one’s eggs allows her to work and learn free of the pressure to have children within a strict window of time. This procedure claims to protect, and even enhance a woman’s fertility with the decision to remove her eggs. Therefore, as a means of circumventing the pain of infertility while empowering women, egg freezing is complexly framed in a way that makes the surgical techniques, the physical distortion and modification of the body, and reimplantation, a way to keep the pregnant female body in tact. As this procedure promises to maintain the integrity of the pregnant female body, we can see it holding together the very social fabric that finds itself threatened by the career woman, and by the complex circumstances she encounters.
How can we measure the implications of a medical procedure that fragments the body both literally, by surgically dislocating human eggs, and metaphorically, in marketing, imaging, and popular media? Most practically, what are the implications in delineating a boundary between a female person and her reproductive, material body parts, and making this boundary the site of object-formation and commodification? Reproductive technologies, like egg freezing, have the potential to change all that we know to have biological truth, certainty, and reality (Franklin 1997). We must strive toward new modes of analysis to meet our changing world. We must focus on how new medical technologies test our moral sensibilities with attention to the social contexts that provide their emergence and application. Bioethical analyses of elective human egg freezing must consider political theory, economics, and more to unveil the ties that this medical technology has to object-formation and identity. Contemporary bioethics and biomedical ethics “speak a language of individual rights and a freedom for individual patients to make choices regarding their treatments in the absence of undue external pressures” (Moazam 2006). Modes of bioethical inquiry that do not attempt to break down or work through the Anglo-American paradigm that underscores what questions we ask will never be enough. What is an individual’s right to determination, as a matter of what is ethical, if we have not thought through how her body became a commodity in the first place?
Framing the questions we ask with respect to controversial medical procedures, within the language, processes, and frameworks that give rise to their emergence, is not enough. If we don’t push these boundaries, we allow marginalized bodies to be caught in impossible debates about whether or not they “should have the right” to certain medical interventions. We become distracted by this question without realizing the subjectivity of medicine itself, as a moral endeavor deeply tied to our moral sensibilities, and to our taken for granted processes which place value on lives themselves. Policy should not intervene until social science research meets these demands. Before we decide what is or is not medically sound, we must demand answers to the most obvious of questions: Why this, why now?