Anonymized donors and recipients’ intersections in the same space: ethical and practical considerations

Abstract

Current demographic changes caused by increasingly ageing populations and declining fertility rates worldwide are raising major social and health challenges. In this context, recourse to Medically Assisted Reproduction (MAR) has increased in the last years within a scenario characterized by differences in national and transnational laws, policies and ethical guidelines regarding its accessibility (e.g. recipients’ maximum age, marital status, sexual orientation), as well as by uncertainties on whether egg and sperm donors should be anonymous or identifiable. These uncertainties and complexities have been used as arguments to encourage patients’ autonomy and informed decision-making through the promotion of patient-centred practices in fertility clinics. Integrated into a broader research project that aims to explore how do social, cultural, and economic characteristics intertwine with the experiences and identities of the various stakeholders involved in gamete donation, this paper intends to examine the complexities associated with patient-centred care practices in the context of heterologous in-vitro fertilization treatment cycles. These practices occur in sociotechnical environments characterized by legal and social constraints, namely legal enforcement of donors’ anonymity and recipients’ stigma. This reflection is based on one hundred hours of daily ethnographic/non-participatory observations focused on health professionals-donors-recipients’ relationships and infrastructures, registered by the first author between May and July 2017 (ongoing observation work until May 2018) and four semi-structured interviews conducted with privileged informants at a public fertility clinic located in Portugal. The existing infrastructures play a major influence on the relationships and dynamics established between the users of this public space. Ethnographic observations identified two critical moments where donors’ anonymity might meet halfway since donors and recipients share simultaneously the same space. These moments are different for men and women: i) female donors and recipients have to do an ultrasound at their first medical appointment, and there is only one ultrasound machine available – thus, it is frequent that donors and recipients share the same room simultaneously; ii) there are two “private” rooms to collect the sperm, and one of them is located in the waiting room, where recipients and other donors are waiting. Additionally, while waiting in the same room, some characteristics might allow the identification of donors and recipients. First, the age, considering that donors tend to be much younger. Second, differences on the relationship established with health professionals, with higher levels of familiarity being observed between recipients and health professionals. Sensitive topics related to the ‘waiting room’ and the ‘private collection room’ emerged spontaneously in the interviews. Women did not feel uncomfortable with the abovementioned situation, but male donors expressed discomfort with the location of the collection room, due to the exposure and lack of anonymity. It was suggested that donors and recipients should be attended in separate spaces to facilitate gamete donation and to promote people-centred care in fertility clinics.