Since the late 1970s, the capacity of assisted reproductive technologies to reorder the beginnings of life has generated robust, sometimes heated social debate. The new repertoires of in vitro fertilisation (IVF) and oocyte donation abruptly expanded the number of potential participants in the creation of a child and radically redistributed the spaces in which ovulation, conception, pregnancy, and birth took place. They propelled existing understandings of the origins of life, women’s reproductive rights, and the structure of the family into potential disarray and hence demanded systematic social deliberation and new legislative frameworks to manage the fallout. In the late 1990s, the creation of the first human embryonic stem cell line (Thomson et al. 1998) and the first mammalian clone (Campbell et al. 1996) galvanised a similarly robust social response. Abruptly, the entities associated with the beginnings of biographical human life, particularly embryos and oocytes, could be diverted from their developmental pathways and transformed into potential sources of therapeutic tissues for patients suffering degenerative conditions. For many people, such developments were profoundly unsettling, and after protracted debate and consultation, many governments in the Organisation for Economic Co-operation and Development (OECD) have tried to broker regulatory compromises that facilitate some degree of stem cell research yet give expression to the special status of the embryo and the need for donor protections (Gottweis et al. 2009).

However, while stem cell research is now considered a well-regulated field in many jurisdictions, and some of the heat has gone out of the debates, it remains highly experimental and retains the capacity to generate sudden and unexpected social conundrums and bioethical issues. As Jackie Leach Scully, Erica Haimes, Annika Mitzkat, Rouven Porz, and Christoph Rehmann-Sutter note in this volume, the social relations generated around acts like embryo donation are still novel and present significant challenges to both ethical reasoning and everyday social life. Moreover, apparently new dilemmas, such as the legal and ethical status of the embryo or the asymmetrical burden placed on female IVF patients as donors of precursor tissues for stem cell research, are thrown up by existing histories of property-in-the-body (Dickenson 2007) or broader concerns over gender relations and equity (Roberts and Throsby 2008). Such issues need to be examined through different theoretical and disciplinary lenses and through the use of different methodologies if their full significance is to be understood.

The articles in this symposium provide various disciplinary perspectives on the emergent social, ethical, and legal relations at play in this dynamic field. For example, what factors influence women in choosing to donate, or not to donate, their embryos or their child’s cord blood for use in research or treatment—and are women treated fairly, for example, when they donate their fresh oocytes (eggs)? And do the women being approached (or “targeted”) to donate their oocytes for reproductive or research purposes feel they are able to make the decision to donate freely, or do they feel coerced or disempowered?

When women are donating their eggs, interviews conducted by Katherine Carroll and Catherine Waldby with patients and health professionals in one Australian clinic show that the women interviewed initially overestimated their chance of success in having a child. After experiencing their first cycle of IVF, these women tended to regard their eggs as more “precious and precarious” than they might first have expected. This acquired “knowledge” could be taken into account in the consent process for egg donation and egg sharing, so that the model for informed consent for egg donation would focus not only on disclosing material information of the usual kind but also the “embodied knowledge” that patients acquire as they undergo fertility treatment. Also, women should perhaps not be asked to donate their eggs at all in the first cycle of IVF (see “Informed Consent and Fresh Egg-Donation for Stem Cell Research: Incorporating Embodied Knowledge into Ethical Decision-Making” by Carroll and Waldby 2012).

With regard to the donation of embryos, qualitative studies by Scully and colleagues in the United Kingdom, Switzerland, and China show that “interpersonal gratitude” or “indebtedness” in general is not a significant factor for donation but instead that many women are motivated by a “solidarity-based desire to ‘give something back’ to medical research.” Interestingly, the commonest reason the women gave for rejecting donation to research was not the moral status of the embryo but, rather, “anxiety and mistrust about what ‘the scientists’ would do with their embryo, which was articulated either as disapproval of specific types of research (e.g., ‘not if it’s for cloning’) or as a more general unwillingness to relinquish responsibility of the embryo to unknown others” (see “Donating Embryos to Stem Cell Research: The ‘Problem’ of Gratitude” by Scully et al. 2012, emphasis original).

The issues with regard to the decision to donate or store umbilical cord blood are, in contrast, inscribed by the mother’s moral obligation to consider the best interests of her child as well as the (weak) obligation she has to society and to the creation of public goods. A survey by Maree Porter, Ian Kerridge, and Christopher Jordens of Australian women concerning their attitudes about donating their child’s cord blood to a public bank rather than storing it for their child’s possible future use suggests that there may be a conflict between the mother’s desire to be a “good citizen” and a “good mother.” Some women based their decision to donate to a public bank on “communitarian values” and the desire to “save a child’s life.” Others wanted to store the cord blood privately “[j]ust in case my own child needs it.” As in other situations where a person must choose between “several different options … and … each option has different advantages and disadvantages and privileges different moral values, it is entirely reasonable that it is difficult to choose between them.” However, “policymakers and health care providers can assist parents to reflect on the information and values that inform these choices by ensuring that information about cord blood banking and donation is accurate, that the benefits of each option are not overstated, and that discussion of the issues is open and critical” (see “‘Good Mothering’ or ‘Good Citizenship’? Conflicting Values in Choosing Whether to Donate or Store Umbilical Cord Blood” by Porter, Kerridge, and Jordens 2012). Thus, the knowledge gained from an empirical study may be used to improve the experience of women in the donation process and perhaps increase the number of donations to public banks.

The law could also take account of women’s experience in donating their embryos, especially their feeling that they had limited control over their embryos following donation. It is inevitable, of course, that women do not have the same legal rights of “autonomy” over embryos they have donated for use in research or by others for reproductive purposes as they have over their own bodies. They can make choices about what will be done or not done with their bodies, but not with their donated embryos (nor indeed to other bodily material they have donated, such as solid organs or regenerative tissue). As Ngaire Naffine and Bernadette Richards note, their “stated wishes … do not produce rights in a strict sense,” as “strong exclusive property rights of ownership” might do (see “Regulating Consent to Organ and Embryo Donation: The Legal Dimensions of the Problem” by Naffine and Richards 2012).

Even though the moral status of embryos is a much older issue—being central to debates about the morality of abortion, assisted reproductive technologies, and developments in research involving embryos and embryonic stem cells—it requires ongoing philosophical examination. It is commonly assumed that such embryos are “harmed” by their own death because they are deprived of the opportunity to live valuable lives as adults. However, as Aaron Simmons makes clear, even though we might agree that embryos are undoubtedly members of the species homo sapiens and are potential persons, it is arguable both that embryos cannot have interests as they are not able to form desires and/or that, if the only feasible alternatives open to embryos are to exist briefly in an unconscious state and then be killed, or not to exist at all, a “rational agent” in a similar situation would choose the former (see “Do Embryos Have Interests? Why Embryos Are Identical to Future Persons But Not Harmed by Death” by Simmons 2012).

When these papers are read together, they should inform our understanding of women’s experiences of donation and the legal, philosophical, and sociopolitical issues that underlie the donation process. Hopefully, this will improve the experience for women in the future in this important but sensitive area.