A NEW PROCREATION STORY: TILE CONTESTED DOMAIN OF TIlE iN VITRO FERTILIZATION PRE-EMDRYO IN BRITISH COLUMBIA by PATRICIA M. LEE B.A. , University of British Columbia, 1987 A THESIS SuBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR TIlE DEGREE OF DOCTOR OF PHELOSOPHY in THE FACULTY OF GRADUATE STUDIES (Department of Anthropology and Sociology) We accept this thesis as conforming Signature(s) removedthe to protectr privacy uired stahdard THE UNiVERSITY OF BRITISH COLUMBIA July 1995 © Patricia M. Lee, 1995 _________________________ In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Signature(s) removed to protect privacy (Signature) Department of The University of British Columbia Vancouver, Canada Date /ffrJ F/99 Signature(s) removed to protect privacy DE-6 (2188) ABSTRACT The human pre-embryo is emerging as a new cultural category as a result of the processes of in vitro fertilization (IVF) technology. The principle purpose of this conceptive medical technology is to assist infertile couples produce their own biological children. I argue that three specific discourses, biomedicine, law and feminism, which have been selected for this research are generating conilicting and contested debates about the cultural values and meanings associated with the human pre-embryo. The physical separation of the pre-embryo as an independent entity created external to a woman’s body enhances its use in medical treatment, diagnosis and research. This phenomenon has facilitated the manipulation of the pre-embryo in the treatment of infertility, preimplantation diagnosis and research into genetically related diseases. The versatility of the pre-embryo for use in both research and treatment has resulted in a growing controversy about its potential for altering the natural relations and sequencing of biological family organization and about its part in a larger social engineering project leading ultimately to change in social structure. A combination of anthropological methods demonstrate the centrality of the pre embryo in the enlarging controversial debates about new reproductive technologies. The biomedical-technical practices of creating, cryopreserving and replacing pre-embryos, which were observed in an ethnographic study of an in vitro fertilization programme provides foundational data for analysis of the three discourses. A critical interpretive approach in medical anthropology situates IVF technology in its cultural and historical context as part of a continuing scientific fascination with understanding the beginnings of life. IVF technology is a gateway into a modem exploration ofhuman genetics, using pre embryos to probe the essential nature of human inheritance. The traditional debates in U anthropology about the cultural nature of parenthood and the juro-political aspects of rules and rights in and over people and things have current relevance. They provide a cultural understanding about the ability of IVF to re-arrange the biological, putative and social relations of parenthood. They reveal the methods whereby legal controls are exerted by groups with different vested interests in children born from IVF and its adjunct therapies, such as surrogacy arrangements and ovum donation. A feminist anthropological perspective explores a recent approach in symbolic anthropology about the cultural meanings of procreation stories, as expressed by women, based on a particular cultural ideology. It reveals the means by which the technologies associated with TVF have the propensity to fragment and devalue women’s bodies, a strategy which is often endorsed by the culturally legitimated knowledge ofmedicine and law. Four overarching unmediated oppositions are identified in the analysis of the three discourses: research science and clinical therapy; experimental risk and routine therapy; ownership (property) and autonomy (persoithood); and technological reproduction (culture) and natural reproduction (nature). The controversies raised by the tension between polarities highlights problems of meaning. These are expressed in the discourses as a struggle over values, which in turn are converted into struggles over power They represent the new cultural meanings and social consequences which are presently emerging in response to new conceptive technologies. m TABLE OF CONTENTS Page ABSTRACT ii TABLE OF CONTENTS iv LIST OF TABLES viii LIST OF FIGURES ix PREFACE: CONCEIVING THE RESEARCH PROJECT x (i) Creating a Feminist Network xii (ii) Offto Foreign Fields at Home xiv ACKNOWLEDGEMENTS xxii CHAPTER 1. IN THE BEGINI1ING 1 I INTRODUCTION 1 (i) What is in vitro fertilization (JVF) technology? 1 (ii) The Three Discourses: Medicine, Law and Femini 4 (iii) The Context: Infertility and the Reign of Technology 6 II A CONCEPTUAL CONFUSION: DEFINING INFERTILITY AN]) THE CONCEPTIJS 8 (i) Infertility as a Terminological Confusion 8 (ii) Mixing our Meanings: Redelining the “Embryo” 12 ifi THEORETICAL PERSPECTiVES 15 (1) Critical Interpretive Medical Anthropology 16 (ii) From an “Anthropology ofWomen” to Feminist Anthropology 21 (iii) A Feminist Approach to Discourse Analysis 23 1V THE BRITISH COLUMBIA WF PROGRAMME 27 V CHAPTER OUTEINE 30 CHAPTER 2. MEANINGS OF CONCEPTION: FROM TRADITIONAL KINSHIP STUDIES TO NEW PROCREATION STORIES IN ANTHROPOLOGY 33 I CONCEPTION THEORIES: TRADITIONAL DEBATES ABOUT PROCREATION IN ANTHROPOLOGY 34 (i) Virgin Births and Concepts ofPaternity 34 II KINShIP AN]) BIOLOGY 36 (1) Cultural Constructs ofBiological Processes 36 (ii) (3enitor/Genetrix: :Pater/Mater: Problems ofParenthood 37 (iii) Categorizing Parents: Some Cognitive Models 39 ifi PROCREATION STORIES: RECONSTRUCTING KiNSHIP AN]) FAMILY 41 iv IV THE POLITICO-JURAL APPROACH IN ANTHROPOLOGY .44 (i) Rights in Rem, Rights in Personam 45 (ii) Twin Universes: Persons and Things 46 V GENDER STUDIES AND REPRODUCTION IN ANTHROPOLOGY 49 (i) Moving Reproduction from “Off-Centre” 49 (ii) Legal Anthropology and Relations ofPower 51 VI CONCLUSION 54 CHAPTER 3. THE MEDICAL DISCOURSE: THE HISTORY OF EMBRYO RESEARCH AND THE BIRTH OF IVF TECHNOLOGY 56 I FROM “FAILURE TO GENERATE” TO “CONCEPTION IN A WATCH GLASS” 58 (i) Classical Greek Models ofProcreation 58 (ii) Preformation Theories 60 (iii) Theories of Ovulation and Embryo Development 61 (iv) The Egg Hunt: The Access to and Ethics ofEmbryology Research.. 63 II 1W AND EMBRYO TRANSFER: NEW WAYS OF MAKiNG BABIES 66 ifi A CHRONOLOGY OF INFERTILITY AND GENETIC SCREENTNG TECHNOLOGIES 71 1V THE MEDICAL DISCOURSE OF INFERTILITY AND SUCCESS: PROBLEMS OF DIAGNOSIS AND CURE 76 (i) The Discourse ofEpidemiology ( Population Studies) 76 (ii) The Numbers Games 78 (iii) “A Take Home Baby”: Measuring the Rhetoric of”Success” 80 V THE CAUSES OF INFERTILITY: MERGING STANDARD MEDICAL, PUBLIC HEALTH AND ENVIRONMENTAL DISCOURSES 82 (i) The Standard Medical Discourse 82 (ii) The Environmental Discourse 84 VI AN 1W PROGRAMME IN BRITISH COLUIVIBIA 87 (i) A Short History 87 (ii) The Current Situation of 1VF in Vancouver 94 (iii) An Uneasy Separation 98 VII CONCLUSION 99 CHAPTER 4. THE MEDICAL-TECHNOLOGICAL DISCOURSE:CREATING AND FREEZING PRE-EMBRYOS 102 I PREPARING FOR THE SUPEROVULATION PROCESS 103 (i) “Ladies-in-Waiting”: Coming “on board” 103 (ii) Counseling the Clients 105 (iii) “Calling the Pergonals”: Calling the Shots 107 V II THE OOCYTE RETRIEVAL OR THE “EGG.PICKUP” .112 (i) The Routinization ofA F[igh Drama 112 (ii) The “Egg Pickup” 115 ifi A WINDOW OF OPPORTUNITY: INTO THE LAB 117 (i) A Mecca ofMachinery 117 (ii) “Egg” Care 120 (iii) Insemination and Syngamy: Technology versus Nature 121 (iv) Cleaving Embryos: Watching, Waiting and Wastage 123 (v) The Embryo Transfer 127 1V FROZEN IN TIME AND SPACE: FREEZiNG PRE-EMBRYOS 128 (i) A Chilly Climate 129 (ii) More than Enough: Freezing Choices 131 (ili) It’s Just a Matter of Time 135 V IDENTIFYING RISKS AND ACKNOWLEDGING THE COMPLICATIONS 138 VI CONCLUSION 141 CHAPTER 5. THE LEGAL DISCOURSE: THE CASE FOR THE PRE-EMBRYO... 145 I CANADIAN VALUES AN]) GUIDING LEGAL PRINCIPLES 146 II PERSON OR PROPERTY: PRECEDENT SETTING CASES IN THE UNITED STATES 148 (i) Reos 149 (ii) Davis v. Davis, Kass v Kass and Jones v. York 150 (ili) Oocyte and Embryo Donation 154 (iv) Fetal Tissue Commerce and Research 155 ifi CREATING A CANADIAN LEGAL FRAMEWORK FOR REGULATING PRE-EMBRYOS 156 (i) The Context of Canadian Health Regulation 156 (ii) Canadian Commissions and Committees for Regulating New Reproductive Technologies (NRTs) 158 1V THE CANADIAN ROYAL COMMISSION ON NEW REPRODUCTiVE TECHNOLOGIES (CRCNRT) 163 (i) Damaged Pre-embryos and Wrongful Life Suits 165 (ii) A Regulatory Agency 166 (iii) Donating and Selling 168 V LEARNING FROM THE PAST: GUARDING AGAINST THE FUTURE 169 (i) The Eugenics Heritage 170 (ii) Judicial Interventions: Maternal/Fetal Disjunctures 172 (iii) Corporate Protectionism: A New Eugenics 176 VI CONCLUSION 177 vi CHAPTER 6. A NEW PROCREATION STORY:FEMINIST DISCOURSES FROM TFIE MARGiNS 180 1S ISSUE 185 1 NEW REPRODUCTiVE TECHNOLOGIES: AWOMEN (i) In Whose Best Interests: Resisting Technology 185 (ii) The Enterprise Culture: Fragmenting Women’s Bodies 191 (iii) The