Doctors as moral pioneers: Negotiated boundaries of assisted conception in Colombia

Abstract

New biotechnologies such as assisted conception are socially embedded artefacts that raise context‐specific ethical, moral and social anxieties. In contexts where the regulations of these profitable developments are limited or ambiguous, and competition between private facilities is high, individual doctors become morally and socially responsible for determining the parameters of administering such therapies. Ethnographic research at two private fertility centres in Colombia reveals that doctors do not determine boundaries based on monetary gain but rather personal morals, social norms and professional obligations. Medical professionals hold diverse perceptions of assisted conception, and often struggle to make decisions regarding who should access such therapies, who are ideal gamete donors and the fate of extra embryos. The complexity of these perceptions applied in a context of limited regulation and the competition of private medicine impacts the praxis of assisted conception. As doctors determine the boundaries of their practice they not only create variation between clinical practices, but also make moral decisions regarding who should be parents, how families should be formed and the significance of embryos. Thus, in navigating their everyday practices, doctors also shape the social world.

A narrative review of challenges related to healthcare worker rights, roles and responsibilities in the provision of sexual and reproductive services in health facilities

“…For example, in Ethiopia, many physicians exercised significant latitude in deciding when a pregnant woman’s life was in danger, and provided abortion services accordingly 34. In Colombia, there were few formal rules regarding the provision of fertility treatment, and so providers who had been trained in fertility treatment provided services, but were forced to ‘negotiate treatment boundaries based on their own morals, social values and professional obligations’ due to the lack of standardised clinical guidelines 49…”

“…In a different setting, hospital leadership, based on their own religious or moral codes, sought to limit the provision of abortion services in their own department by not facilitating staff training and not procuring manual vacuum aspiration kits 42. Finally, providers can seek to directly influence the decision-making of their own patients, such as by trying to convince women seeking an abortion not to obtain one, even if they have a legal right91; or dissuading adolescents from obtaining contraception,76 or anyone seeking fertility treatment 49…”

Exploring the Multiplicity of Embodied Agency in Colombian Assisted Reproduction

“…Gupta and Richters (2008: 247) explain that the experience of ‘objectification through reproductive technologies depends on several factors, which vary across the world and in individual cases’, including the social and structural constraints that shape women’s lives and the cultural meanings ascribed on the body. The nature of the highly competitive private medical system in which ARTs are provided in Colombia where doctors often invest their own finances in their clinics and are highly dependent on the recommendations of their patients/clients (Shaw, 2019) may create a more equal power dynamic between patient/client and doctor and help facilitate more labour-intensive care than that found in other locales. Furthermore, the women who participated in this study all lived middle or upper-class lives, the majority were well-educated and most had supportive husbands and/or extended families.…”

“…In what follows, I aim to explore how agency manifests during different moments of objectification in high-tech infertility treatment. I will draw on data from 10 months of ethnographic research in two infertility centres in Bogota, Colombia, and interview transcripts from 87 in-depth interviews with women (or couples) undergoing assisted conception (Shaw, 2018, 2019). All women whose narratives are presented in the following analysis identified as heterosexual and all but one were married.…”

“…All women whose narratives are presented in the following analysis identified as heterosexual and all but one were married. These women held a variety of professional and administrative posts, apart from one who was voluntarily unemployed, and lived middle to upper-class lifestyles, a necessity to be able to afford the relatively high costs of Assisted Reproductive Technologies (ARTs) in Colombia (see Shaw, 2019). Their experiences using ARTs varied greatly, some of them having only undergone one cycle, while others had undergone various cycles and used donor materials.…”