Systemic ableism in reproductive medicine at the state- and sub-state levels

Some national legislation and regulatory guidelines (for instance in the UK and in Australia) restrict the use of in vitro fertilization and pre-implantation genetic testing to choose embryos with genetic differences leading to disabilities for transfer into a patient’s uterus. Furthermore, it is common for individual reproductive medicine clinics to have similar restrictive policies, and for professional guidelines to permit individual providers to refuse to participate in the transfer of embryos that could likely result in children with disabilities. This paper presents scenarios in which prospective parents might want to choose to transfer embryos with genetic differences that could lead to disabilities. I argue that such restrictive legislation, regulations, policies, and guidelines are examples of systemic ableism – bias against people with disabilities. They are ableist because these systemic features of reproductive medicine fail to respect the autonomous choices of prospective parents, and fail to adhere to the norm of liberal neutrality. I examine harm-prevention arguments, “open future” arguments, and comparative choice arguments that could be used to justify these systemic features of reproductive medicine. Each type of argument is notably weak. I also note that in complex systems like clinics and hospitals, there are potentially innocent explanations for these ableist systemic features of reproductive medicine. As such, allegations of systemic ableism will commonly be clouded by ambiguity. However, I argue that these potentially innocent explanations also fail to justify policies and guidelines that result in preventing prospective parents from choosing to transfer embryos with genetic differences. Clinical trial number: not applicable.