Suitability for Parenthood
Such pronounced medical reluctance to offer AID as a treatment for infertility leads us to consider how the women consulting these doctors were characterized and treated. As evidenced by their testimony to the Feversham Committee, some doctors further justified their lack of involvement in AID, or denial of treatment in specific cases, by stressing the female patient’s lack of suitability. These problems tended to be of a more emotional or psychological nature, rather than physical. Representatives from the Royal College of Surgeons of Edinburgh noted: ‘One finds most of the women who are infertile suffer from various forms of neurosis’.81 While such characterization of all infertile women as psychologically damaged appears to have been a particularly extreme viewpoint, within the context of the testimony received, even those practising AID on a regular basis, such as Bernard Sandler, mentioned their need to refuse treatment to some women ‘on psychological grounds’.82 He described ‘a certain type of woman who can become quite obsessional about her childlessness’, and considered infertility ‘one symptom, if you like, of a general disturbance of the whole personality’.83
In addition, several gynaecologists chose to characterize those women who sought AID in a similarly dysfunctional way. Thus, Hector Maclennan described most of the patients who approached him for this form of treatment as being ‘of a highly nervous disposition’, ‘frustrated and introverted’, and ‘a bit emotionally disturbed’.84 Similarly, Audrey Freeth criticized the wife who ‘must have a child at any price’, indicating ‘a lack of understanding and an emotional immaturity’ that did ‘not augur well for the future of that marriage’ .85 While it was natural that a married woman would wish for a family, she could want this too much and thus get ‘carried away emotionally’.86 Some of the psychiatrists who submitted evidence to Feversham were similarly minded. Eustace Chesser automatically regarded a woman seeking AID as ‘unstable’, and suggested that her motives ‘must be largely neurotic’, since ‘normal people would prefer adoption’.87 London-based psychiatrist G.W.B. Jones had ‘always been struck by the obsessional attitude of women’ he had met ‘who had requested (or demanded) AI’. He added: ‘Most seemed to be in need of psychiatric treatment rather than semen’.88
Even noted advocates of the therapy, such as Bernard Sandler, might make damning remarks about the type of woman seeking AID, and those who failed to conceive thereby. In his oral evidence to the Committee,
Sandler suggested that ‘emotionally immature women often failed to conceive’, and that even where treatment succeeded in such cases, it was ‘not always [... ] with very happy results’.89 Rather more curiously, he discussed a woman’s ability to conceive only when she had made a ‘conscious decision’ to do so: ‘She has to decide whether she is having a baby or new curtains or a new car or giving up a profession and therefore this is a conscious decision’. Eleanor Mears noted that perhaps half of the couples who she rejected for AID were rejected on the grounds of their psychological instability.90
More common still was acknowledgement of the inevitably damaging nature of the AID treatment itself. This featured particularly prominently in the evidence presented by the two witnesses who had practised AID on a smaller scale but since discontinued the practice. Albert Sharman discussed the ‘danger of psychological damage to the patients, both husband and wife’, ‘either through the inevitable interference with their sexual relations or through the consciousness of reproductive inferiority’.91 Eustace Chesser no longer offered AID ‘because of the psychological significance’.92 He was disturbed by one patient ‘who treated him as the father’, and noted the ‘tremendous blow’ to the male partner’s pride, ‘confirmed by their reluctance even to have sperm counts undertaken’. He warned that ‘couples could not forget that their child was an AID child’, particularly the husband, for whom AID ‘reflected his own inadequacy and broke the marriage bond’.
The potentially damaging impact of AID upon marriage was a focus of attention in the witness statements of numerous other doctors, but particularly psychiatrists. It was expressed unanimously that single women were not and should not be treated with AID, so the relationship at the heart of these patient consultations was commonly reflected upon. David Stafford-Clark argued that a woman ‘pregnant by semen which her husband had not contributed’ had ‘received something intrinsically sexual from outside the marriage’, ‘the final seal on the husband’s incapacity’. He flagged up the related ‘danger that the child would be made to suffer at a later stage’, summing up that ‘human beings were not as rational as AID presupposed them to be’.93 Similarly, John McDonald suggested that AID was problematic for any less than perfect marriage, for the birth of a child by this procedure would constitute ‘a standing reminder’ of ‘already disturbed family relationships’.94 Echoing Chesser’s experience, McDonald added that the female patient ‘may even feel that she is committing adultery with the doctor’. An unnamed forensic medicine lecturer at the University of Edinburgh expressed the related view that ‘denigration of the family concept [... ] was the most extensive and serious cause of mental disturbance and human maladjustment’, the implication being that AID would compromise the integrity of the ‘natural’ family unit.95 This mixture of concerns on the psychological impact of infertility and its treatment has strong resonances with Jacky Boivin and Sofia Gameiro’s contribution to this volume.
Adding further complexity to the issues raised was the treatment option of ‘AIHD’, the practice of inseminating a woman with a mixture of semen from her husband and an anonymous donor. The technique appears to have been adopted predominantly in the hope that the couple would believe that they had conceived naturally, though Reynold Boyd was atypical in employing AIHD because it was ‘virtually impossible to guarantee sterility’, thus the husband had ‘a chance of fatherhood in almost every case’.96 Most who supported the practice noted that the procedure of mixing sperm might mitigate some of the psychological dangers inherent in donor insemination, including damage inflicted upon the self-esteem of infertile husbands and the ‘stigma of “test- tube” origins’ suffered by resulting children who became aware of their status.97 The procedure might make the husband ‘feel that he had a chance of being the father’,98 or, as Mary Barton put it, ‘let the couple have their little bit of pleasant doubt’.99
Expressed in fuller detail, Albert Sharman’s technique involved not telling the husband when he was totally sterile, but having a ‘heart to heart talk’ with his wife and asking her to keep that information to herself.100 As he put it, ‘I told the wife she was not to go home and blurt out the whole truth of the matter [... ] I saw marriages going on the rocks, ruin and divorce, through telling the husband’. The husband was instead told that he was ‘impaired’ but that there was ‘hope with treatment or in time things might remedy themselves’, thus any resulting pregnancy using AIHD might be passed off as resulting from marital intercourse. Going further still, Eleanor Mears ‘did not believe in telling a man he was sterile’,101 so asked him to provide a specimen for the purposes of artificial insemination, but tended then not to use it, using only donor semen. Several doctors also noted that, whether or not AIHD was used, the couple was encouraged to
‘lead a normal married life’ (i.e. to have marital intercourse) during artificial 102
However, most medical witnesses who expressed serious reservations about AID extended their deep concerns to AIHD. Summing up these concerns, a group from the University of Edinburgh’s faculty of medicine argued that this mixture of semen led to ‘unnecessary confusion and ambiguity’, made the ‘accurate’ keeping of records ‘impossible’, and that it was fundamentally dishonest to place the couple in a position where they did not know whether or not the husband was the father of their child.103 Hector Maclennan similarly stressed the dishonesty of the procedure, adding that since he objected in principle to AID, ‘mixing it up with the husband’s semen does not strike me as making it any more right. It is just putting a cloak over it’.104 For perhaps more practical reasons, the Royal College of Obstetricians and Gynaecologists argued that in no case was AIHD warranted: if the husband was not sterile, donated semen should not be used at all, and if he was sterile, the use of his semen was ‘pointless’.105
Given the inherently dishonest nature of AIHD, medical hypocrisy in characterizing the infertile woman herself as somehow ‘duplicitous’ is striking. Doctors from the Royal College of Surgeons of Edinburgh, for example, noted that steps must be taken to ensure that such women were ‘genuine and honest’ in their desire for such treatment.106 Meanwhile, in cases of AIH and AIHD, Albert Sharman cautioned that female patients being asked ‘to bring along a specimen of the husband’s semen’ must also be requested to supply proof that this was indeed her husband’s semen and that he had consented to the procedure.107 After all, as Sharman complained, ‘the woman could bring along a substitute semen if she so felt [... ]. We have no proof: we are injecting it in good faith’. When a member of the Feversham Committee retorted that this point was surely ‘only a theoretical one’ since any woman who would ‘go to the trouble of bringing the semen of a man other than her husband’ would ‘surely try ordinary methods of adultery’, Sharman responded defensively that he had ‘no doubt [... ] from the way an occasional woman talked to him, that she did indulge in adultery’.108
In a bid to counter such allegations, Bernard Sandler wrote to the Feversham Committee, subsequent to appearing before them, with a case that had just been referred to him.109 It involved a couple married for seven years, who had adopted a child after two years of marriage upon the discovery that the husband had incurable sterility. Having found that adoption ‘did not satisfy either of them’, and seemingly with no other options available, ‘after very much thought and consideration’ the wife arranged ‘to have intercourse with another man, with her husband’s full knowledge and consent’. The intended outcome of this adulterous encounter, a natural birth, was successfully achieved. The couple then wished for a further child, but ‘neither [... ] felt able because of the emotional strains’ of this adulterous method. Some years later, ‘only when the publicity of last year in the press revealed to them that there was such a practice as AID did they feel that this was the method of choice for them’. Sandler stressed the importance of this case in illustrating that, ‘contrary to what the critics think, AID is a highly moral and ethical procedure which in the rare cases such as this one will actually avoid immor- ality’.110 As another of AID’s strongest advocates and most enthusiastic practitioners, Margaret Jackson wrote similarly: ‘Many of the couples asking for AID seem to regard it as a special form of adoption [... ]. They are deeply hurt if they are told that AID is tantamount to adultery - that is precisely what they
wish to avoid’ .111
Nonetheless, for those doctors who appear to have conflated AID with adultery and moral taint, this story is likely to have done little to dissuade them of their belief. While most witnesses were sympathetic to the woman’s plight, in her unsuccessful quest for motherhood, Hector Maclennan was not alone when he stated that barren women had ‘been there since the old days, in the Old Testament’, ‘a tragedy as old as history’, and that modern medicine was providing false hope to such women. ‘It would be far better’, Maclennan argued, for such patients to ‘face the fact [... ] and be told to adopt than that she should go from clinic to clinic’ with such a small chance of successful treatment.112 Such medico-moral discussion of infertile women seeking treatment bears a striking resemblance to the religious testimony received. Thus, the Church of Scotland asked the infertile to accept ‘the mysterious workings of Providence [... ] without resentment and in quiet trust’,113 while the Free Church urged the childless ‘to recognise the Divine will’ and to ‘pray for submission’, which would ‘maintain the sanctities of the marriage bond and the joys of the marriage relationship in a way that was impossible by the [adulterous] methods of artificial insemination’.114