The second ethical implication of a stricter definition of reproduction is that all those who collaborate in the begetting and/or bearing stages of reproduction share the rights and responsibilities of reproduction, regardless of their intent—or lack of intent—to rear the resulting child. This is also regardless of whether their collaboration consists of genetic, gestational, or medical input. It is not controversial to suggest that reproduction generates, for those who reproduce, both rights and responsibilities to the child who is born. Indeed, this point is well established in the reproductive rights literature (Almond 2008; Benatar 2010). For example, O’Neill writes

… the right to beget or bear is not unrestricted, but contingent upon begetters and bearers having or making some feasible plan for their child to be adequately reared by themselves or by willing others. People who beget or bear without making any such plans cannot claim that they are exercising a right (O'Neill 1979, 25).

Others, such as Steinbock and McClamrock, develop a principle of parental responsibility where it could be morally wrong to intentionally conceive “when conditions are sufficiently awful that having children might be viewed as incompatible with being a good parent and unfair to the child” (Steinbock and McClamrock 1994, 15). This position holds that those involved in creating children have a degree of moral responsibility to consider the resulting child (Benatar 2010).

I accept this position in the literature, acknowledging that in the sexual realm this is limited to the female and male of the sexual union. However, in this paper I argue that the number of individuals who collaborate in the reproductive process expands in the move from sexual to non-sexual reproduction. In this realm, the number of people collaborating in the reproductive process at the point of begetting a child (triggering conception) expands to include fertility clinicians who provide ART.

I argue that having a “lack of intention to rear” the resulting child does not extinguish reproductive rights or responsibility. This is intuitively understood in the sexual realm, where the male and female of the sexual union are the sole collaborators in this reproductive process,Footnote 5 and are the only two individuals to whom reproductive rights and responsibilities apply. Their intention or lack of intention to rear does not alter the normative assignment of reproductive rights and responsibilities upon them. Nor does their intent or lack of intent to rear alter the automatic conferral of parental recognition and responsibilities upon them when the child is born. Again, while rearing rights and responsibilities may flow on automatically from reproduction, this does not mean that they are the same.

In the non-sexual realm, collaboration in the stages of begetting and bearing expands. Begetting a child non-sexually requires fertility clinicians to join the process at this point of conception through the provision of ART treatment. The hopeful parent/s will also potentially require the collaboration of gamete donor/s and a surrogate to gestate and give birth to a child. These begetting and bearing roles can be completed by different individuals, some of whom have no intention to rear. I have argued in a previous paper that the rights and protections accorded to hopeful parents seeking to reproduce sexually are not sui generis reproductive rights at all (Hall 2022). Rather, reproduction is the assertion of three pre-existing and foundational moral rights: sexual freedom (to have sex, and to gestate for the female), bodily sovereignty (to have sex, to continue a viable pregnancy for the female), and the personal liberty to ask somebody to have sex with them (with reproductive intent). Indeed, I suggest that the reproductive right is no more than a right to try to reproduce, which is a necessarily weaker and narrower freedom to try to achieve anything. My point is that while a hopeful parent may seek to reproduce, unless they have the involvement of others (who are equally free to join the process, or not), they will not achieve this goal. If the person who is asked to have reproductive sex with a hopeful parent refuses to do so, there is—I have suggested—no violation of the hopeful parent’s reproductive right. It could be the assertion of their own (sexual) freedom to not have intercourse with the hopeful parent or of their bodily sovereignty to not engage in any of these proposed activities.

This rationale extends into the non-sexual reproductive realm and applies to all who join the process (Hall 2023). In other words, rights and responsibilities towards the child who is born are generated not only for the intended parents, but also for the gamete donors, surrogates, and clinicians who all collaborate in the creation of a child (even though none of these seek to rear the child they help create).Footnote 6 Creating a child is an activity with a morally significant outcome, and on this basis, everybody who joins has the right to refuse to do so. All of these collaborators who beget the child have moral freedom to join the process, when asked, or to refuse. Joining is not a morally neutral act. The grounds upon which clinicians would be ethically justified in refusing differ from those who provide genetic or gestational input and would need to comply with existing professional and legal standards of anti-discrimination and equity. However, the basis upon which such refusal is ethically justified remains the same as for any reproductive collaborator. I additionally suggest that the state collaborates in non-sexual reproduction on the grounds that it regulates and in many jurisdictions subsidizes ART treatment. The state additionally has broadly recognized duties to consider future generations, which could include the future child born of ART treatment. However, the scope of this paper does not extend to substantive consideration of state-as-reproductive-collaborator, so I shall set this aside, while recognizing that such responsibilities to consider the welfare of future children may be relevant in relation to the state. Lack of an intention to rear the child has, I argue, shrouded the collaborative role of donor, surrogate, and clinician in the process to date in the literature, and the moral rights and responsibilities generated by these collaborative roles in ART have been ignored on the grounds that they do not seek to rear. I will briefly discuss the collaborative role of the fertility clinician, as the purpose of this paper is to explore the ethical implications of a revised definition of reproduction for ART provision.

The clinician has been framed as a morally neutral machine operator, of only instrumental significance in the reproductive process of hopeful parents. This is an understandable misconception, as the contribution of fertility clinicians does not create a biological connection with the future child. Nor do they intend to bear or rear the child they help to create. I recognize that clinician involvement in non-sexual reproduction not only differs from their role in the sexual realm but also differs from the role of hopeful parents (who intend to rear and beget and bear the child) and gamete donors or surrogates (who will beget and/or bear the child, thereby forming a biological connection with the child). I suggest that fertility clinicians are not “reproducers” in the same way as these other contributors are to the reproductive process. Their actions are not morally protected by any reproductive liberty assertion. However, I suggest that they nonetheless join the reproductive process through their involvement in performing ART interventions at the begetting stage of triggering conception.

I suggest that they “produce” a child through their collaboration. Their actions qualify for collaborative involvement, in line with the definition of causation as set out by Mackie (Mackie 1965). Applied to the fertility clinician’s role in the birth of a child via ART, I suggest that the involvement of a fertility clinician is an unnecessary condition for the conception of a child, but it is sufficient to contribute to the conception of a child non-sexually. Viewed from a different angle, the provision of ART by the fertility clinician is an insufficient but necessary part of the conception of a child non-sexually. On these grounds, I suggest that, similar to Mackie, the fertility clinician is likewise all of these things in triggering conception in the non-sexual reproductive process. These facts render the clinician a collaborator in the birth of children conceived non-sexually. I have argued in an earlier paper that, based on this collaborative involvement in a process with a morally important outcome, clinicians can ethically refuse to provide ART on three grounds: a) a conscientious objection asserted due to their personal code of ethics as an autonomous moral agent, b) professional duties of beneficence and non-maleficence to all who are implicated in or impacted by the treatment provided, and c) as agents of the state, carrying out their professional activities lawfully (Hall 2023).

The moral implications of a position that acknowledges a collaborative role of the clinician in triggering non-sexual reproduction could, and arguably should, have broader implications for the moral role of clinician involvement at other points in both sexual and non-sexual reproduction. For example, prior to the act of sexual intercourse which may lead to fertilization and implantation, clinicians are able to explore and sometimes treat physical problems affecting either or both sexual partners which may be preventing them from reproducing, such as treatment for malfunctioning pituitary glands or for polycystic ovaries, the prescription of ovarian hyper-stimulating drugs, or performing uterine ablation for females to remove cysts or scar tissue to prepare the uterus for implantation. Likewise, the points of gestation and childbirth can often benefit from substantial medical intervention which follows conception achieved via either means. While a substantive analysis of the moral role of reproductive collaborators at these other points on the reproductive continuum would be a valuable contribution to the literature of reproductive rights, I confine my analysis to an examination of the moral role of those who collaborate in triggering conception, as this is a fundamental difference between sexual and non-sexual reproduction.

Causal accounts of parenthood are extensively debated in the ART context in the literature (Nelson 2000; Bayne and Kolers 2003; Munson 1988; Callahan 1992; Fuscaldo 2006). These accounts largely seek to determine who, of those who create a child, has a greater parental claim over children they are involved in creating. Are the genetic ties morally binding, or more morally binding than gestational and/or intentional accounts of parenthood? However, prior to determining parental recognition for a child born via ART, I argue it is a more pressing moral task to take a step back and consider who, of all those who collaborate in the process, has moral responsibility for the creation of a child via ART. I suggest that regardless of whether or not they seek to stake a parental claim over the child, all those who collaborate in triggering conception of a child have moral rights and responsibilities towards that child. My point is that while it is important to establish parentage for every child born, it is equally important to establish who bears moral accountability for the child’s birth—that is, who has duties and obligations towards the future child. I argue these responsibilities are generated for anybody who collaborates in triggering the conception of a child. This is particularly so in the case of ART, where the creation of a child is both the intended and foreseeable outcome of the process, and includes the collaboration of clinicians through the provision of treatment. I suggest this has not been considered in the literature to date because the clinician has no intention to rear the child that is born. The literature focuses on the reproductive rights and duties of those with an intention to rear. I argue that it is morally unimportant to the reproductive process itself who intends to rear or who does not intend to rear the child that is created. If one’s actions or input are necessary conditions for triggering conception in either realm, I suggest that one has collaborated in the creation of any child that results from the conception.