Mitochondrial donation, patient engagement and narratives of hope

'False hope' in assisted reproduction: the normative significance of the external outlook and moral negotiation

Despite the frequent invocation of 'false hope' and possible related moral concerns in the context of assisted reproduction technologies, a focused ethical and conceptual problematisation of this concept seems to be lacking. We argue that an invocation of 'false hope' only makes sense if the fulfilment of a desired outcome (eg, a successful fertility treatment) is impossible, and if it is attributed from an external perspective. The evaluation incurred by this third party may foreclose a given perspective from being an object of hope. However, this evaluation is not a mere statistical calculation or observation based on probabilities but is dependent on several factors that should be acknowledgeable as morally relevant. This is important because it allows room for, and encourages, reasoned disagreement and moral negotiation. Accordingly, the object of hope itself, whether or not based on socially embedded desires or practices, can be a topic of debate.

Making patients political: Narrating, curating, enacting, and navigating the 'idealised policy patient'

In this article we develop the concept of the 'idealised policy patient' to contribute to a better understanding of patient-family activism and the mechanisms through which powerful and persuasive patient narratives are facilitated and mobilised. The context through which we explore the idealised policy patient is the UK debates about the legalisation of mitochondrial donation, which primarily took place between 2011 and 2015. In our example, the idealised policy patient was constructed around a culturally persuasive narrative of patient suffering, where mitochondrial donation was presented as a desirable and ethical solution. We draw on interviews with patient-families and stakeholders, and documentary analysis to identify four dimensions of the idealised policy patient - narrating, curating, enacting and navigating. Narrating describes how the idealised policy patient appears in public and policy spaces, as a culturally available narrative which conveys certain meanings and is designed to invoke an emotional and practical response. Curating identifies the multiple forms of labour and facilitation involved in supporting patient-families in activist activities which strengthen the dominant narrative and its embodiment. Enacting focuses on the work of patient-families themselves in supporting and contributing to the idealised policy patient in a way that enlivens and embodies the specifically curated narrative. Finally, navigating considers how those offering an opposing viewpoint position themselves in relation to the idealised policy patient. To conclude, we argue that medical sociology has often given insufficient scrutiny to how the capacity of patients to leverage their status for political ends is bolstered through alignment with existing powerful groups, particularly in hegemonic campaigns. We encourage future researchers to examine how the idealised policy patient is reproduced and reorientated within different policy contexts.

Infertility, reproductive timing and 'cure' in families affected by Turner Syndrome

This article discusses the influence of a chromosome condition affecting women's reproductive capacity, Turner Syndrome (TS), on affected women's social timing, examining the strategic decisions that are made within families in relation to reproduction, to navigate these disruptions. Based on photo elicitation interviews with 19 women with TS and 11 mothers of girls with TS in the UK, it presents findings from an under-researched topic, TS and reproductive choices. In a social context where motherhood is not only desirable, but expected (Suppes, 2020), the social imaginary of infertility anticipates a future of unhappiness and rejection, an undesirable condition that should be avoided. Accordingly, mothers of girls with TS often expect that their daughter will want to have children. Infertility diagnosed in childhood has a distinctive impact on reproductive timing, as future options may be anticipated for years. This article uses the concept of 'crip time' (Kafer, 2013) to explore how women with TS and mothers of girls with TS experience temporal misfitting based on a childhood diagnosis of infertility, and manage, resist and re-frame this to minimise stigma. The 'curative imaginary' (Kafer, 2013), a social norm where disabled people are expected to desire a cure for their condition, is used as an analogy for infertility, describing how mothers of girls with TS respond to social pressure to plan for their daughter's reproductive future. These findings may be useful both for families navigating childhood infertility and practitioners who support them. This article demonstrates the cross-disciplinary potential of applying disability studies concepts to the context of infertility and chronic illness, where concepts shed new light on the dimensions of timing and anticipation in this context, improving our understanding of the lived experience of women with TS, and how they view and use reproductive technologies.

Silences, omissions and oversimplification? The UK debate on mitochondrial donation

Drawing on scholarship from ignorance studies, this paper uses the case of the UK debates on mitochondrial donation (2012-2015) to emphasize the importance of deploying an analysis of ignorance that goes beyond medical and safety concerns when scrutinizing debates or campaigns around new reproductive technologies. In contrast to what happened with previous reproductive health treatments or drugs, the potential medical risks of mitochondrial donation were explicitly acknowledged and examined during its public and parliamentary discussions. However, I show, using the concepts of 'acknowledged unknowns' and 'ignored knowns', how the attention drawn to the medical risks contributed to obscuring the assessment of its economic and social impacts by silencing key knowledge regarding the limitations of mitochondrial donation in relation to the potential beneficiaries, the scope of the techniques, their alternatives and their costs. This article therefore calls for more systematic use of an integrated analytical framework of ignorance to be applied in the field of reproductive public policies, paying particular attention not only to the ways that medical risks are addressed, but also to the type of knowledge and disciplines this allows to silence or side-line in the framing and assessment of new biotechnologies.

The crafting of hope: Contextualising add-ons in the treatment trajectories of IVF patients

The proliferation and popularity of additional treatments in IVF, also known as add-ons, has generated widespread discussion and controversy in the UK, where concerns have addressed the lack of evidence to support the efficacy and safety of these treatments, their cost, and their connection to a wider context of privatisation of fertility treatment. Drawing on 42 interviews with IVF patients, this article explores the role of hope in the appeal of add-ons from the patient perspective. The analysis is presented in two parts: firstly, we investigate the role of hope in patients' decision-making on treatment, contextualising add-ons in the broader trajectory of their IVF experience; secondly, we examine how patients navigate the offer of add-ons, focusing on the role of hope in how they rationalise their decisions on whether to include them in their fertility treatment. Our analysis shows how patients craft their hope to navigate the increasing number of available options in their quest to find the treatment(s) that will "work" for them. We suggest that the imperative for patients to explore all options is intensified with the emergence of add-ons, which produces a novel context and version of a "hope technology".

Tempering hope with Intimate Knowledge: Contrasting emergences of the concept 'uninfectious' in HIV

In this paper, we contrast two emergences of the concept of 'uninfectious' (that pharmaceuticals can render someone living with HIV non-infectious) in HIV. First, using Novas' framing of 'political economies of hope', we describe the deployment of 'uninfectious' as part of global health campaigns. Second, we draw on Raffles' (International Social Science Journal, 2002, 54, 325) concept of 'intimate knowledge' to theorise our own account of 'uninfectious' through a re-analysis of qualitative data comprising the intimate experiences of people living with or around HIV collected at various points over the last 25 years. Framed as intimate knowledge, 'uninfectious' becomes known through people's multiple engagements with and developing understandings of HIV over a prolonged period. As contingent and specific, intimate knowledge does not register within the biomedical/scientific ontological system that underpins discourses of hope employed in global campaigns. The concept of intimate knowledge offers the potential to critique discourses of hope in biomedicine problematising claims to universality whilst enriching biomedical understandings with accounts of affective, embodied experience. Intimate knowledge may also provide a bridge between different epistemological traditions in the sociology of health and illness.

Powering life through MitoTechnologies: exploring the bio-objectification of mitochondria in reproduction

Mitochondria, the organelles providing the cell with energy, have recently gained greater public visibility in the UK and beyond, through the introduction of two reproductive technologies which involve their manipulation, specifically ‘mitochondrial donation’ to prevent the maternal transmission of inherited disorders, and ‘Augment’ to improve egg quality and fertility. Focusing on these two ‘MitoTechnologies’ and mobilising the conceptual framework of “bio-objectification”, we examine three key processes whereby mitochondria are made to appear to have a life of their own: their transferability, their optimisation of life processes and their capitalisation. We then explore the implications of their bio-objectification in the bioeconomy of reproduction. Drawing on publicly available material collected in two research projects, we argue that mitochondria become a biopolitical agent by contributing to the redefinition of life as something that can be boosted at the cellular level and in reproduction. Mitochondria are now presented as playing a key role for a successful and healthy conception through the development and promotion of MitoTechnologies. We also show how their “revitalising power” is invested with great promissory capital, mainly deriving from their ethical and scientific biovalue in the case of mitochondrial donation, and from the logics of assetisation, in the case of Augment.

Development of mitochondrial replacement therapy: A review

Mitochondrial replacement therapy (MRT) is a new form of reproductive invitro fertilization (IVF) which works on the principle of replacing a women's abnormal mitochondrial DNA (mt-DNA) with the donor's healthy one. MRT include different techniques like spindles transfer (ST), pronuclear transfer (PNT) or polar body transfer (PBT). Transmission of defective mitochondrial DNA to the next generation can also be prevented by using these approaches. The development of healthy baby free from genetic disorders and to terminate the lethal mitochondrial disorders are the chief motive of this technique. In aged individuals, through in vitro fertilization, MRT provides the substitution of defective cytoplasm with cured one to enhance the expectation of pregnancy rates. However, moral, social, and cultural objections have restricted its exploration. Therefore, this review summarizes the various methods involved in MRT, its global status, its exaggerated censure over the years which depicts a strong emphasis for social acceptance and clinical application in the world of medical science.

Public attitudes towards novel reproductive technologies: a citizens' jury on mitochondrial donation

STUDY QUESTION

Does an informed group of citizens endorse the clinical use of mitochondrial donation in a country where this is not currently permitted?

SUMMARY ANSWER

After hearing balanced expert evidence and having opportunity for deliberation, a majority (11/14) of participants in a citizens’ jury believed that children should be able to be born using mitochondrial donation.

WHAT IS KNOWN ALREADY

Research suggests that patients, oocyte donors and health professionals support mitochondrial donation to prevent transmission of mitochondrial disease. Less is known about public acceptability of this novel reproductive technology, especially from evidence using deliberative methods.

STUDY DESIGN, SIZE, DURATION

This study comprised a citizens’ jury, an established method for determining the views of a well-informed group of community members. The jury had 14 participants, and ran over one and a half days in 2017.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Jurors were members of the public with no experience of mitochondrial disease. They heard and engaged with relevant evidence and were asked to answer the question: ‘Should Australia allow children to be born following mitochondrial donation?’

MAIN RESULTS AND THE ROLE OF CHANCE

Eleven jurors decided that Australia should allow children to be born following mitochondrial donation; 7 of whom added conditions such as the need to limit who can access the intervention. Three jurors decided that children should not (or not yet) be born using this intervention. All jurors were particularly interested in the reliability of evidence, licensing/regulatory mechanisms and the rights of children to access information about their oocyte donors.

LIMITATIONS, REASONS FOR CAUTION

Jurors’ views were well informed and reflected critical deliberation and discussion, but are not intended to be representative of the whole population.

WIDER IMPLICATIONS OF THE FINDINGS

When presented with high quality evidence, combined with opportunities to undertake structured deliberation of novel reproductive technologies, members of the public are able to engage in detailed discussions. This is the first study to use an established deliberative method to gauge public views towards mitochondrial donation.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by a University of Sydney Industry and Community Collaboration Seed Award (2017), which was awarded contingent on additional funding from the Mito Foundation. Additional funding was provided by the Mito Foundation. The Foundation was not involved in jury facilitation or deliberation, nor analysis of research data.

TRIAL REGISTRATION NUMBER

Not applicable.

Reproductive Politics in Twentieth-Century France and Britain

This special issue adopts a comparative approach to the politics of reproduction in twentieth-century France and Britain. The articles investigate the flow of information, practices and tools across national boundaries and between groups of experts, activists and laypeople. Empirically grounded in medical, news media and feminist sources, as well as ethnographic fieldwork, they reveal the practical similarities that existed between countries with officially different political regimes as well as local differences within the two countries. Taken as a whole, the special issue shows that the border between France and Britain was more porous than is typically apparent from nationally-focused studies: ideas, people and devices travelled in both directions; communication strategies were always able to evade the rule of law; contraceptive practices were surprisingly similar in both countries; and religion loomed large in debates on both sides of the channel.