O-220 Automation and the future of fertility care: An ethical analysis of empowerment-oriented innovation

Abstract

Abstract Study question What do the anticipated ethical benefits of automation oriented innovations in assisted reproductive technology teach us about the future of ethical assessments of fertility services? Summary answer Benefits like democratization and empowerment to justify disruptive innovation in the fertility field may obscure more fundamental ethical concerns about justice, self-surveillance and reproductive/parenthood ideals. What is known already It is believed that combining robotic components and artificial intelligence may yield an automated ‘lab in a box’ that reduces costs of gamete selection, fertilization, embryo development and genetic testing. Earlier references to ‘fertility labs in a box’ focused on functionality in traditional laboratory setups. Present-day rhetoric instead emphasizes the assumedly democratizing potential, aimed at transforming the fertility sector from reactively treating infertility to proactively managing fertility. Accordingly, the idea is to go after the ‘bigger market’ of preventive management of fertility, to allegedly empower people to reproduce at a time that is most convenient. Study design, size, duration A literature study was performed to inventory how future visions of automated, low-cost and anticipatory fertility management are gaining momentum, not only as marketing efforts of private companies, but also in academic literature among medical professionals and researchers. It was observed how these aspirations are justified with reference to moral values like empowerment and equality. This was critically evaluated against the backdrop of ethical arguments, indicating that beyond apparent benefits there are weighty moral questions. Participants/materials, setting, methods Literature study, conceptual analysis, normative analysis. Main results and the role of chance The anticipated ethical benefits of automated ‘fertility labs in a box’ are couched with high hopes about affordable and democratic fertility services and about empowering individuals to become managers of their own reproductive future. The ethical value of these benefits may seem to resonate with the importance of reproductive autonomy and just access. Yet, it is debatable whether these reproductive technological innovations that are promoted under the flag of empowerment, reproductive autonomy and accessibility will actually have a beneficial impact in terms of these values. It may be questioned how empowering it is to provoke demand for an unproven service that is supposed to vouch for reproductive goals that individuals may, or may not have later in life. More fundamentally, by fixating on the narrow way in which central ethical values like equality, autonomy and empowerment are employed to justify revenue-driven steps towards an automated fertility lab of the future, other crucial questions might be hedged. As will be shown during this presentation, careful ethical analysis can expose that more fundamental questions should be asked about economic constellations, self-surveillance, and fundamental matters pertaining to what ought to be valued, rather than what is valued or desired about human reproduction. Limitations, reasons for caution This is an agenda-setting analysis, and so it is not meant to serve as an exhaustive discussion of these moral concerns. While automated fertility labs are a speculative matter indeed, these perspectives are nonetheless gaining momentum, not only as commercial rhetoric, but also in scientific literature. Wider implications of the findings These findings instigate reflection about (bio)ethical analysis by accentuating the importance of contextual and global elements that may propel or restrain individuals’ reproductive options. This analysis also connects with earlier forms of ‘disruptive innovation’ rhetoric related to egg freezing enterprises as a way to transform infertility treatment into fertility management. Trial registration number N/A